Spectraforce Technologies
Quality Improvement Abstractor
Spectraforce Technologies, Houston, Texas, United States, 77246
Job Title: Quality Improvement Abstractor
Job Location: Remote - CST
Job Duration: 4+ Months
DescriptionResponsible for collecting medical records by looking through claims and outreaching to providers, handling pends from Vendors, Pulling charts from EMR
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.
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
Internal/External Groups with which the Candidate will interface:
Required Skills/Experience:
Preferred Skills/ Experience:
1.HEDIS experience-must1.Looking through claims to chart chase
2.Knows hybrid measures-must2.Working with vendors-Datafied, Datavant
3.Working in EMRs3.Familiar with QMRM
Education Requirement:Nurse preferredEducation Preferred:BSN
Job Location: Remote - CST
Job Duration: 4+ Months
DescriptionResponsible for collecting medical records by looking through claims and outreaching to providers, handling pends from Vendors, Pulling charts from EMR
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.
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
Internal/External Groups with which the Candidate will interface:
Required Skills/Experience:
Preferred Skills/ Experience:
1.HEDIS experience-must1.Looking through claims to chart chase
2.Knows hybrid measures-must2.Working with vendors-Datafied, Datavant
3.Working in EMRs3.Familiar with QMRM
Education Requirement:Nurse preferredEducation Preferred:BSN