Senior Quality Improvement Abstract

Overview

Presbyterian is seeking a Senior Quality Improvement Abstract

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.

We're determined to take care of those working in healthcare.

Presbyterian is dedicated to improving people's lives - the lives of our patients and the lives of our coworkers. We're a locally owned and operated, which encourages supportive leadership that empowers employees. And we provide the opportunity to grow from entry-level to the most senior positions.

Why Join Us

• Full Time - Exempt: Yes
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Days
• 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

Qualifications

• Associate degree or 3 years of additional experience in lieu of degree
• LVN/LPN with HEDIS experience, and 3-4 years clinical experience

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. This position includes all of but not limited to the following tasks/functions:
• 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.
• Perform quality reviews of peer performance relating to medical record abstraction documentation.
• Utilize remote applications such as laptop, scanner and other devices.
• Other duties as assigned (may include administrative functions such as RightFax).
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies, and other applicable corporate and departmental policies. Maintain complete confidentiality of company related business.
• Maintain effective communication with management and peers regarding development within areas of assigned responsibilities and perform special projects as required or requested.
• Willing to travel and ability to drive, using personal transportation for frequent local travel.

Benefits

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian? As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services Presbyterian exists to ensure the patients, members and communities we serve can achieve their best health. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Maximum Offer for this position is up to

USD $37.58/Hr.

Compensation Disclaimer

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.