RN/LPN- Abstract Senior
US-NM-Albuquerque
Careers (External)
Req #: 45291
Type: Full Time
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Overview: Now hiring a RN/LPN- Abstract Senior Oversees and performs the Medical Record Retrieval, Review and Reporting process to support HEDIS, STARs, HEDIS Like, supplemental, and other required regulatory reporting as well as PHP Board approved health management initiatives across the enterprise. The role assists with ensuring clinical and fiscal improvements and documents service delivery in accordance with Presbyterian Health Plan policies. The Senior Abstractor will be asked to perform duties where clinical decision-making may be necessary, training and over read responsibilities. How you belong matters here. We value our employees' differences and find strength in the diversity of our team and community. At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members. Why Join Us * Full Time - Exempt: Yes * Job is based Rev Hugh Cooper Admin Center * Work hours: Weekday Schedule Monday-Friday * Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees * Ideal Candidate: Bachelor Degree. Registered Nurse (RN) with minimum 2 years clinical experience, Knowledge of medical terminology, knowledge of standard medical practices, medical assistant, medical coding or data management experience. Knowledge of Microsoft Applications, including Excel and Access Responsibilities: * Uses Performance Improvement tools and techniques to develop work plans, tasks, timelines, and measurements for all health management project assignments. Project plans will be developed for all projects and milestones monitored and reported. * Identifies needs, designs valid and reliable tools for data collection, analyzes data, researches data and claims, and provides feedback in an appropriate format. May assist with development and implementation of quality initiatives. Monitors outcomes and quality of services provided. * Performs Medical Record Reviews necessary to support quality initiatives and regulatory reporting, including but not limited to HEDIS reporting, CMS Star measures, FEHB measures, Medicaid, and supplemental data reporting. May be held to productivity standards as well as minimum over read standards. * Manage an assigned caseload of provider locations and provide verbal and written progress regarding status of each providers submission of requested medical records. Excellent communication and facilitation skills are keys to success. * Identify, analyze, and collect clinical information as it applies to HEDIS and NCQA requirements. *Identify probable findings indicated by clinical documentation in the medical record. * Documents abstracted findings into a HEDIS database tool. * Track and report on issues and outcomes related to abstractions and over-reads. * Integrate data collected from a variety of electronic and paper sources. * Communicate significant findings, including potential risk management issues to the Manager in a timely manner. * Auditing to ensure compliance and accuracy of data abstraction and review * Mentor abstractors in improving overall skill sets * Manage an assigned caseload of provider locations and provide verbal and written progress reports regarding the status of each provider's submission of requested medical records. * Request medical records via most appropriate method, depending on each provider (fax, email, mail or site visits, using secure external drive or scanning, etc.). * To abstract medical record documentation for Health Effectiveness Data and Information Set (HEDIS) and other initiatives as assigned. * Organize, schedule, and conduct on-site medical record abstraction visits as needed. * Communicate with assigned providers to ensure compliance to requests. * Work with peers, leadership, and other departments as needed to ensure timely retrieval and abstraction of medical records. * Convert files to usable .pdf documents for abstraction. * Correctly name, save, and manage files on the Shared Drive for medical records and other project documentation as assigned. * Following the HEDIS Technical Specifications to obtain, analyze, and evaluate medical record documentation submitted for HEDIS measures [annual National Committee for Quality Assurance (NCQA) quality profile * Assist in developing criteria for medical record and site reviews. * Assist in developing educational and training materials as requested. * Assist in identifying barriers, planning interventions, and implementing activities to enhance and improve provider medical record and HEDIS documentation. * Assist in identifying and implementing interventions to better improve Service delivery to members. Qualifications: * Associate degree or 3 years of additional experience in lieu of degree * LVN/LPN with HEDIS experience, and 3-4 years clinical experience
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