Medical Record Reviewer - LPN

Capital Blue Cross • Harrisburg, PA

5h • Hybrid

About The Position

The Medical Record Reviewer will be responsible for the review and abstraction of medical records utilized for annual HEDIS submission. This role involves tracking data submission, informing management of any trends, barriers, or backlog, and interpreting clinical data submissions to accurately process records or return them with detailed reasons. Additional duties may include medical record retrieval, either onsite or via remote access, participation in annual HEDIS hybrid record processes, and involvement in Health Outcomes Improvement Team initiatives.

Requirements

• Active Licensed Practical Nurse (LPN) license.
• 1-2 years of medical record review experience.
• Knowledge of Facets, Excel and various software used for medical record abstraction documentation.
• Knowledge of Medical Terminology.
• Proficient in using electronic health records (EHR).
• 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.
• Ability to act both independently and as part of a team while adapting to changing priorities.
• Analytical skills.

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.
• Track data submission and inform management of any trends, barriers, or backlog.
• Interpret clinical data submissions to accurately submit records for processing or return the records to the submitter in a timely manner with detailed return reasons.
• 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.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Retirement Plan
• Generous time off including Paid Time Off
• Holidays
• Volunteer time off
• Incentive Plan
• Tuition Reimbursement
• Flexible environment where your health and wellbeing are prioritized
• Investment in training and continuing education

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 501-1,000 employees