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Innovative Systems Group · 1 day ago

Clinical Specialist

Chicago, IL

Full-time

Hybrid

Mid Level

$47/hr - $47/hr

3+ years exp

Innovative Systems Group is seeking a Quality Audit Specialist responsible for ensuring the audit and review of electronic clinical records. The role involves oversight of clinical data abstraction/extraction processes, auditing supplemental files for quality measures, and contributing to the integrity of the Medical Record validation process.

ConsultingInformation Technology

Responsibilities

Ensures the audit and review of electronic clinical records to ensure they accurately reflect medical record documentation to meet regulatory and accrediting compliance mandates

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

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

Contributes toward the achievement to maintenance of accreditation with national accreditation agencies

Demonstrates strong multi-tasking setting priorities based upon minimal direction

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, language 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

Applies structured auditing criteria to abstract medical records, follows defined procedures for saving approved medical record documentation and accurately enters the results of chart audits

Maintains complete confidentiality of company related business

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

Qualification

NCQA HEDIS measuresClinical validationData analysisMS Office SuiteEMR/EHR familiarityMulti-taskingEffective communicationConfidentiality

Required