Hedis Abstractor

RESPONSIBILITIES:

- The HEDIS Abstractor, External Audits and Quality Control, conducts validation and production checks on medical records abstracted for the HEDIS Project and supplemental medical record review.
- This individual assures abstractions are complete and compliant with HEDIS specifications and guidelines.
- This individual works with the HEDIS manager to assure the measures required by NCQA, DHS, MRMIB, and other regulatory agencies are met.
- This individual abstracts medical record information and enters data on the electronic HEDIS forms (tool).
- This individual works directly with abstractors from Partners to track productivity and accuracy, and initiate discussion with the abstractors when differences are identified upon the medical record over-read.
- When appropriate, this individual contacts the external HEDIS auditor on questions regarding an interpretation of the HEDIS specification.
- During the off-season after the HEDIS project is completed, this individual conducts audits at provider offices and provides feedback to office staff, provider on documentation, and medical record coding.
- This individual is part of the HEDIS team and is responsible for motivating the staff, comply with NCQA HEDIS requirements, set high standards related to medical record abstraction, participate in programs to educate providers and nursing staff, write flow charts and policies and procedures pertinent to abstraction.
- The nurse abstractor will participate in quality improvement meetings and operational meetings as assigned.
- This individual will also participate in special projects as assigned.

SKILLS:

EDUCATION/EXPERIENCE:

- A.A. degree in health care sciences, nursing, ir health information systems; Strong background in medical terminology, anatomy and physiology required.
- BSN preferred.
- A minimum of ten years experience as a HEDIS abstracter lead and/or other Quality Improvement, Quality Management experience in a managed healthcare setting.
- Demonstrated understanding of Medicare Star program, ICD 9 and CPT coding; Must have demonstrated ability to accurately abstract at least 120 records per day with an accuracy rate of 98% or higher.
- Demonstrated proficiency in accurately abstracting all hybrid HEDIS measures.
- Has experience as a lead with the ability to assess work load and complete projects on time.
- ICD 10 coding; HCC coding; Project management preferred.

LICENSES/CERTIFICATIONS:

- Active, valid, unrestricted CA RN license; or LVN with demonstrated advanced HEDIS abstraction skill sets and experience; or RHIA or RHIT.