Description: Job Profile Summary
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
Custom Fields:
Name: Which Health Plan, programs or functions will this work support?
Value: Carolina Complete Health
Name: If this request is replacing a previously canceled request, please provide the original Request ID
Value: None
Name: Shortlisting Date
Value: None
Name: Field Worker
Value: No