Quality Improvement Abstractor

Presbyterian Healthcare Services•Albuquerque, NM

13d•$35

About The Position

Overview Presbyterian is seeking a talented Quality Improvement Abstractor The Quality Improvement Abstractor Performs the Medical Record Retrieval, Review, and Reporting process to support HEDIS, STARs , HEDIS Like, supplemental, and other required regulatory reporting as well as PHP Board approved health management initiatives across the enterprise. The role assists with ensuring clinical and fiscal improvements and documents service delivery in accordance with Presbyterian Health Plan policies. Full Time - Exempt: Yes Job is based Rev Hugh Cooper Admin Center Work hours: Days Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees. Ideal Candidate: LVN/LPN or Certified Coder Knowledge of medical terminology, knowledge of standard medical practices, medical assistant, medical coding or data management experience

Requirements

High School Diploma or equivalent
2-3 years healthcare experience
Experience working within Electronic Health Records
Experience with medical terminology, knowledge of standard medical practices, medical assistant, medical coding or data management experience

Nice To Haves

LVN/LPN or Certified Coder
Knowledge of medical terminology, knowledge of standard medical practices, medical assistant, medical coding or data management experience

Responsibilities

Uses Performance Improvement tools and techniques to develop work plans, tasks, timelines, and measurements for all health management project assignments. Project plans will be developed for all projects and milestones monitored and reported.
Identifies needs, designs valid and reliable tools for data collection, analyzes data, researches data and claims, and provides feedback in an appropriate format. May assist with development and implementation of quality initiatives.
Monitors outcomes and quality of services provided.
Performs Medical Record Reviews necessary to support quality initiatives and regulatory reporting, including but not limited to HEDIS reporting, CMS Star measures, FEHB measures, Centennial Care, and supplemental data reporting. May be held to productivity standards as well as minimum over read standards.
Manage an assigned caseload of provider locations and provide verbal and written progress regarding status of each providers submission of requested medical records. Excellent communication and facilitation skills are keys to success.
Identify, analyze, and collect clinical information as it applies to HEDIS and NCQA requirements.
Identify probable findings indicated by clinical documentation in the medical record. Documents abstracted findings into a HEDIS database tool.
Track and report on issues and outcomes related to abstractions and over-reads.
Integrate data collected from a variety of electronic and paper sources.
Communicate significant findings, including potential risk management issues to the Manager in a timely manner.
Manage an assigned caseload of provider locations and provide verbal and written progress reports regarding the status of each providers submission of requested medical records.
Request medical records via most appropriate method, depending on each provider (fax, email, mail or site visits, using secure external drive or scanning, etc.).
To abstract medical record documentation for Health Effectiveness Data and Information Set (HEDIS) and other initiatives as assigned.

Benefits

Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.
The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities - like challenges, webinars, and screenings - with opportunities to earn gift to earn gift cards and other incentives.

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