Medical Record Analyst

What We Provide

• Referral bonus opportunities

• Generous paid time off (PTO), starting at 20 days of paid time off and 9 company holidays

• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability

• Employer-matched retirement saving funds

• Personal and financial wellness programs

• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care

• Generous tuition reimbursement for qualifying degrees

• Opportunities for professional growth and career advancement

• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Interacts directly with provider offices, clinics, and other healthcare facilities on the retrieval of medical records for review and abstraction pertaining to HEDIS/QARR/Risk Adjustment and other focused audits/studies. Provides guidance on protocol as required.

• Schedules and performs onsite medical record reviews with high volume providers for compliance with HEDIS/QARR/Risk Adjustment standards.

• Manages and organizes scanned medical records in a central repository inclusive of performing data entry, scanning relevant components of the medical record to support reviews performed, and using appropriate naming convention.

• Safeguards confidentiality of the medical charts/records and complies with all local, state, and federal laws pertaining to medical records. Assures compliance with all HIPAA regulations concerning use, retrieval, storage, and sharing of medical records.

• Educates providers and office staff on HEDIS/QARR quality metrics, Risk Adjustment specifications, and medical record review criteria.

• Participates in required trainings. Participates and assist in quality improvement audits, Risk Adjustment Data Validation (RADV) and other Risk Adjustment surveys and focused studies.

• Maintains a comprehensive understanding of the QM and Risk Adjustment (RA) policies and procedures and ensure compliance.

• Accesses scanned copies of medical records in appointed vendor tool or from Client's VPN directory.

• Follows up on all outstanding issues found during medical record review. This includes initiation and completion of chart issues.

• Accesses EMR's to get pertinent information.

• Evaluates documentation discrepancies identified during initial review and advises on corrective actions as appropriate. Reviews and enters documentation findings into a database.

• Abstracts medical data from medical records assigned to consultant in a precise and proficient manner.

• Abstracts data, annotate medical records and enter information into the appointed vendor data collection tool per HEDIS MY 2024 specifications.

• Provides accurate assessment of provider performance against HEDIS/QARR standards and procedures. Responsible for clinical audits needed across products.

• Assists with getting provider attestations for Medical Records with signature impairment for any government audit.

• Participates in special projects and performs other duties as assigned.

Education:

• Associate's Degree in Nursing, Health Care Administration, Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coder, Allied Health professional or other health related field required

Work Experience:

• At least two years of experience in medical record retrieval and review required or

• Quality Management Only:

• A year quality improvement experience in Medicare, Medicaid or Commercial Health Plan Knowledge of HEDIS/QARR standards, medical terminology, strong computer and organizational skills required

• Ability to evaluate medical records with attention to detail required

• Ability to use databases and prepare reports as needed required

• Ability to multitask and troubleshoot problems independently. required

• Effective oral and written communication and interpersonal skills required

• Proficient in personal computer, preferably Microsoft Windows Word, PowerPoint, Excel and Access required