Medical Record Reviewer

Capital Blue Cross•Harrisburg, PA

22h

About The Position

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” The position will complete review and abstraction of medical records utilized for annual HEDIS submission. The reviewer will be required to track data submission and inform management of any trends, barriers, or backlog. The position requires interpretation of clinical data submissions in order to accurately submit records for processing or return the records to the submitter in a timely manner with detailed return reasons. Other responsibilities may include medical record retrieval either onsite or via remote access throughout the year, participation in annual HEDIS hybrid record processes, involvement in Health Outcomes Improvement Team initiatives.

Requirements

Ability to communicate effectively and professionally, both verbally and in writing with various audiences.
Ability to plan, organize and coordinate multiple tasks and priorities.
Ability to perform duties with minimal supervision. Includes the ability to act both independently and as part of a team while adapting to changing priorities.
Analytical skills
Knowledge of Facets, Excel and various software used for medical record abstraction documentation. Medical Terminology
Proficient in using electronic health records (EHR).
1-2 years of medical record review experience.
Must have active current Licensed Practical Nurse (LPN) license.

Responsibilities

Review patient records to ensure documentation aligns with medical, legal, regulatory, and insurance standards.
Abstract appropriate supporting documentation into abstraction tool.
Support audits for internal quality control or external compliance (e.g., Medicare/Medicaid, insurance carriers).
Collaborate with healthcare providers or internal staff to clarify unclear or incomplete documentation.