Senior Quality Improvement Abstract

Presbyterian Healthcare Services

31d•$51,210 - $78,166•Remote

About The Position

Build your Career. Make a Difference. Presbyterian is hiring a skilled Senior Quality Improvement Abstract to join our team. Presbyterian is seeking a talented Senior Quality Improvement Abstract Oversees and 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. The Senior Abstractor will be asked to perform duties where clinical decision-making may be necessary, training and over read responsibilities.

Requirements

High School Diploma Required
LVN, LPN, Coding Certification or other healthcare related field
Knowledge of medical terminology, knowledge of standard medical practices, medical assistant, medical coding or data management experience
Knowledge of Microsoft Applications, including Excel
At least one year of prior HEDIS Chart Abstraction experience

Nice To Haves

Bachelor Degree
Registered Nurse (RN) with minimum 2 years clinical 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, Medicaid, 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.