Quality Improvement Abstractor

Job Description:

Job Tittle: Quality Improvement Abstractor

Location: Remote

Duration: 8 Months (Possible Extensions)

Shift: 8AM – 5PM (Mon-Fri)

Walk Me Through The Day To Day Responsibilities Of This The Role And a Description Of The Project (Outside Of Workday JD):

Completing HEDIS Medical record abstractions and overreads.

Describe the performance expectations/metrics for this individual and their team:

Individual Production

Retrievals  70/day

Abstractions      48/day

Overreads   60/day

Uploads (within 24 business hours) 15/hour

Faxcom Retrieval (within 24 business hours)     10/hour

Email Retrieval (within 24 business hours)      10/hour

MRO Retrieval (within 24 business hours)  15/hour

QSHR Outstanding and Unassigned (OU) Review     10/hour

Individual Quality

Individual Abstraction and Overread Accuracy    98%

Quality Rating - Overall      98%

Quality Rating - By Measure   98%

Position Purpose:

Lead data collection and abstraction for company quality measures, including HEDIS, CMS, CHIPRA and/or any other custom measurements.

Education/Experience:

Associate’s degree in related field or equivalent experience. Bachelor degree preferred. 4+ years of nursing, medical assistant, medical coding or data management experience. Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards) preferred. Advanced knowledge of Microsoft Applications, including Excel and Access.

Licenses/Certifications:

Current state’s RN or LPN license preferred.

Responsibilities:

• Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards
• Review medical records and abstract data for HEDIS and other measure sets in compliance with standards
• Track and report on issues and outcomes related to abstractions and over-reads
• Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required
• Perform other quality initiatives as necessary