HEDIS Abstractor

Job Description

Under direction of Performance Program’s leadership team, the P4P/STAR/HEDIS Abstractor will provide timely and accurate medical record review, enter data findings into abstraction tool, review/over-read data entry/provide feedback, identify chase opportunities, facilitate retrieval of medical records and track progress of efforts. Must exhibit knowledge and competence of NCQA guidelines, HEDIS Technical Specifications and HEDIS Measure Detail while adhering to PP Dept Policies and Procedures. The abstraction team will meet chart abstraction productivity standards as well as minimum over read standards.

Responsibilities

• Coordination and preparation of the HEDIS medical record review project which includes but not limited to ongoing medical records review, auditing of medical records submitted by providers, onsite visits for provider feedback, training on proper documentation.
• Accurately enter 95% of data into abstraction tool and/or ICE files
• Collaborate with Quality Care Coordinators in Stars/HEDIS related activities/MR retrieval
• Ensure privacy and security of Protected Health Information, (PHI) in compliance with HIPAA
• Read and adhere to NCQA HEDIS Technical Specifications and annual updates
• Communicate changes, create, update and maintain HEDIS training materials
• Follow Policy and Procedures for naming and saving records appropriately
• Assists Manager and Supervisor(s) in training and takes a lead role in these activities, utilizing the standardized training materials and job aids.
• Communicate to supervisors any challenges, technical issues, or inability to meet deadlines
• Responsible for maintaining Stars/HEDIS Calendar events and completing assigned tasks on time
• Visit provider offices as needed for in person training on HEDIS measures and how to abstract/close care gaps in HEDIS engine
• Responsible for reporting and attempting to resolve Heat Ticket issues internally or with vendor
• Works with NCQA to monitor accuracy of abstracted records as required by specifications
  
  

Qualifications

Minimum Education: Bachelor's Degree or certified coder or equivalent experience highly preferred

Minimum Experience: Minimum three (3) years of experience in healthcare with minimum 2 years coding and medical record abstraction experience. One (1) year managed care experience, RN or LVN valid license preferred.

Req. Certification/Licensure: None

"Location-Based Pay Adjustment"

About Us

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.