Medical Record Review Auditor – Temporary, Part-Time (

PacificSource Health Plans•Springfield, OR

11d•Remote

About The Position

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Temporary contract position to review medical charts. Medical records will be reviewed to find documentation and compliance for HEDIS performance measures. Data elements being sought are laboratory results, blood pressures, body mass index, colon cancer screening, and other aspects of care. Essential Responsibilities: The auditor will review medical records obtained by a vendor and available electronically at the PacificSource office. The medical record review on the members in the population will be performed according to NCQA HEDIS specifications. Data will be entered using certified HEDIS software on laptop computer after training has been completed. The medical record will be reviewed for confirmation of member identification, data elements, numerator events and exclusions per HEDIS specifications outlined on MRR tools in the certified software system. Numerator events and exclusions will be documented in the software program and by photocopying, printing, or capturing a digital image of the page of the medical record where the event or contraindication is found. Ability to audit with 95% accuracy. Protect PHI by never leaving laptop in car. Always lock computer when leaving its location. Do not reveal passwords. Do not discuss PHI with anyone who does not have a legal need to know. All photocopied medical records will be handled according to the health plan confidentiality and safe guarding PHI policy and procedure. Supporting Responsibilities: Meet department and company performance and attendance expectations. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned. SUCCESS PROFILE Work Experience: Acute care experience or experience in a primary care clinic or experience with disease management. Experience using or viewing electronic medical records. Experience performing chart audits preferred. Education, Certificates, Licenses: Valid nursing license (RN or LPN). Competencies: Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work remotely and occasional inside a general office setting with ergonomically configured equipment. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times. PacificSource is anything but a typical health insurance company. Founded in 1933, we’re an independent, not-for-profit organization that puts our members, and their communities first—across Idaho, Oregon, Montana, and Washington. It's our employees who make it happen: promoting health equity and partnering with providers to deliver better access to optimal, affordable care. So yes, with PacificSource, you get to do great things. In our effort to put members first—more than 600,000 of them—initiative, commitment, and hard work are supported and rewarded with excellent benefits, competitive wages, and opportunities for personal growth and advancement. Benefits: Flexible telecommute policy, medical, vision, and dental insurance, incentive program, paid time off and holidays, 401(k) plan, volunteer opportunities, tuition reimbursement and training, life insurance, and options such as a flexible spending account. We love our common purpose. Empowerment, flexibility, and sharing success make for a great place to work. Here’s what else we feel good about: A mission with a real sense of shared values Competitive wages and outstanding benefits, including telecommuting Opportunities for learning development and career advancement Organizational leadership style rooted in servant and transformational leadership A commitment to support the communities we serve A belief in the importance of work-life balance More to come! PacificSource is an equal opportunity employer and a company that loves helping people. We work with our employees to understand their goals, and provide training, individual development, and career advancement opportunities to help them achieve just that. Top Workplace 2025 and 2024 USA | USA Today 2025 Healthcare Top Workplaces | Energage Top Workplaces # 6 Healthiest Employer of Oregon 2025 | Portland Business Journal Top Workplace 2024, 2023 and 2022 for Oregon and SW Washington | The Oregonian Top Workplace 2025, 2024, 2023 and 2022 for the Treasure Valley | Idaho Press Certified Age Friendly Employer, 2023 | Age Friendly Institute PacificSource is an equal opportunity employer. Click here to review our AAP Policy Statement. If you have questions about working at PacificSource or need help with your application, please email [email protected].

Requirements

Acute care experience or experience in a primary care clinic or experience with disease management.
Experience using or viewing electronic medical records.
Valid nursing license (RN or LPN).
Adaptability
Building Customer Loyalty
Building Strategic Work Relationships
Building Trust
Continuous Improvement
Contributing to Team Success
Planning and Organizing
Work Standards
Accountability
Collaboration
Communication (written/verbal)
Flexibility
Listening (active)
Organizational skills/Planning and Organization
Problem Solving
Teamwork
Stoop and bend.
Sit and/or stand for extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing.
Light lifting and carrying of files and business materials.
Ability to read and comprehend both written and spoken English.
Communicate clearly and effectively.

Nice To Haves

Experience performing chart audits preferred.

Responsibilities

The auditor will review medical records obtained by a vendor and available electronically at the PacificSource office.
The medical record review on the members in the population will be performed according to NCQA HEDIS specifications.
Data will be entered using certified HEDIS software on laptop computer after training has been completed.
The medical record will be reviewed for confirmation of member identification, data elements, numerator events and exclusions per HEDIS specifications outlined on MRR tools in the certified software system.
Numerator events and exclusions will be documented in the software program and by photocopying, printing, or capturing a digital image of the page of the medical record where the event or contraindication is found.
Ability to audit with 95% accuracy.
Protect PHI by never leaving laptop in car. Always lock computer when leaving its location. Do not reveal passwords. Do not discuss PHI with anyone who does not have a legal need to know.
All photocopied medical records will be handled according to the health plan confidentiality and safe guarding PHI policy and procedure.
Meet department and company performance and attendance expectations.
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.