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Mindlance · 2 days ago

HEDIS Quality Audit RN

Chicago, IL

Contract

Onsite

Mid Level

Mindlance is seeking a Quality Audit Specialist responsible for ensuring the audit and review of electronic clinical records to meet regulatory compliance mandates. The role involves oversight of data abstraction from Electronic Medical Records and contributes to maintaining accreditation with national agencies.

Human Resources

H1B Sponsor Likely

Hiring Manager

Kunal Choudhary

Responsibilities

This position is responsible for ensuring the audit and review of electronic clinical records to ensure they accurately reflect medical record documentation to meet regulatory and accrediting compliance mandates

This position will be responsible for oversight and review of the abstraction/extraction process of clinical data from Electronic Medical Records (EMRs); auditing supplemental files supplied by providers and vendors for HEDIS, Quality Rating System (QRS) and other quality measures; identifying areas of opportunity to improve documentation and audit outcomes

This position impacts the integrity of the Medical Record validation process and HealthCare Effective Data & Information Set (HEDIS) Reporting

In addition, this position significantly contributes toward the achievement to maintenance of accreditation with national accreditation agencies

Individual must demonstrate strong multi-tasking setting priorities based upon minimal direction including:

Understanding of NCQA HEDIS quality measures and code value sets

Conducts clinical validation on incoming supplemental data files

Maintains standard operating procedures (SOPs), user guides to reflect accurate and updated processes

Educates internal and external stakeholders (e.g., providers, vendors) in supplemental processes

Supports clinical validation during the onboarding process including primary source verification (PSV) during official/mock audits

Conducts analysis and investigation on inquiries related to medical records data collection tied to technical specifications

Collaborates with technical staff in performing research and assist in data analysis

Maintains productivity level with less than a 5% error rate in record abstraction and data entry on an ongoing basis

Strong proficiency with tools, language11 MS Office Suite: MS Word, MS Excel, MS PowerPoint, and MS SharePoint

Familiar with HIX (Health Insurance Exchange), EMR (Electronic Medical Record), EHR (Electronic Health Record) types of data collection

Apply structured auditing criteria to abstract medical records, follow defined procedures for saving approved medical record documentation and accurately enter the results of chart audits

Maintain complete confidentiality of company related business

Maintain effective communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested

Qualification

HEDIS quality measuresElectronic Medical RecordsData analysisMS Office SuiteMulti-taskingEffective communicationConfidentiality

Required