The Analyst is responsible for conducting medical record reviews that contribute to HEDIS and Stars quality improvement. This role assists in researching and compiling appropriate and relevant data for Quality services.
Conducts primary medical record abstractions and quality assurance overreads during HEDIS Medical Record Review and Supplemental Data seasons
Assists with reporting during HEDIS season.
Partner with Provider Engagement Coordination (PEC) team and conduct medical record review for new and existing clients.
Assists in the research, analysis, identification, and evaluation of data from assigned problems to evaluate existing and potential trends and issues.
Maintains comprehensive knowledge of business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies.
Assists in monitoring initiatives, outcomes, and objectives to ensure goal attainment within defined parameters.
Assists in development of lines of communication to discuss/review results of analysis to management via reports/presentations and assists management in implementing programs that provide solutions.
Assists leadership by investigating, reviewing, and recommending innovative solutions which identify problems/root cause of issues.
Assists in identifying resolution of challenges and issues in order to fulfill key corporate objectives and responds to the demands of change management and initiates actions needed to plan, organize, and control team activities.
Assists in development of plans, reports, papers, and/or other material creation.
Provides assistance and feedback to corporate staff as required.
Assists with and documents feedback between corporate business areas and participates in group or committee discussions.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
Bachelor's degree in Business Administration, Nursing, Health Information Management/Technology, Health Care, Information Systems, Statistics, or a related field. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification, e.g., Registered Health Information Technician (RHIT), or progress toward certification is highly preferred and encouraged.
One year experience in a related field, typically in at least two of the following areas is preferred: Health Information, nursing, planning, health care economics, health care policy, statistical modeling, business decisions, analysis, or business management. Experience in healthcare with HEDIS knowledge and experience in medical record review is preferred.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
Knowledge of HEDIS medical record review process
Knowledge of EMRs and healthcare information technology
Ability to abstract and overread medical records according to HEDIS technical specifications
Strong analytical, planning, problem solving, verbal, and written skills to communicate complex ideas.
Ability to develop project management, meeting process, and presentation skills.
Strong ability to work independently and direct the efforts of others.
Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).
Ability to work independently, within a team environment, and communicate effectively with employees and clients at all levels.
Administer and adhere to corporate and departmental policies, practices and procedures.
Ability to read Spanish preferred
Work is performed in an office setting with no unusual hazards.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.