Medical Record Reviewer, remote, part-time

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage

Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.

We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

The Medical Record Reviewer carries out key initiatives related to reporting and improving HEDIS for Mass General Brigham Health Plan. The primary responsibility of this position will be managing the HEDIS medical records review project including coordination of medical records data collection and chart reviewing. This position will facilitate appropriate medical records data collection for the EQRO (External Quality Review Organization) auditing and all other medical records review, such as medical records document standards review, and also facilitate collection of race/ethnicity and language data from PCP practice sites.

• Manages relationships with provider sites to collect data for HEDIS, EQRO, NCQA (National Committee for Quality Assurance), and race/ethnicity and primary language data for various projects in Mass General Brigham Health Plan
• Medical record review process includes
  • Assisting with training program for the abstraction of the necessary medical record
  • Assisting with coordinating and scheduling of on-site reviews at PCP practice sites and hospitals
  • Conducting over-reads
  • Revising and updating HEDIS medical record review tools to reflect specification changes
  • Monitoring completion and compliance rates during the HEDIS reporting period
  • Securing successful medical record review
• Supports the submission of final HEDIS results to our auditors, NCQA and the state Medicaid office.
• Coordinates the medical records documentation standards review process that includes
  • Revising and updating review tools
  • Selecting sites for review based on Mass General Brigham Health Plan's policy
  • Performing onsite review
  • Tabulating and disseminating review results
  • Providing technical assistance for documentation improvement to sites
• Hold self and others accountable to meet commitments.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate AllWays Health Partners as a people-first organization.
• Works with Clinical Quality Assurance Nurse Auditor staff to assist with the Auditing and compliance process.
• Contributes to cross-functional projects led by other departments, where appropriate.

Required:

• Bachelor’s Degree or the equivalent combination of training and experience, plus 3 years of medical records review experience.
• Must be an RN, LPN, Certified Coder, RHIT, RHIA, MA or Medical Records professional

Preferred/Desired:

• Have a history of successfully coordinating a HEDIS medical record review project

RN Preferred

Strongly Preferred/Desired:

• 3 years of medical record review experience
• Have a history of successfully completing HEDIS medical record reviews
• Be able to work collaboratively with staff throughout the organization
• Ability to use HEDIS medical records review tool and to manipulate data in Excel and/or Access
• Ability to manage competing deadlines and handle multiple tasks simultaneously
• Excellent verbal and written skills

Project and budget management experience

• Respects the talent and unique contribution of every individual, culture, and ethnic group and treat all people in a fair and equitable manner.
• Exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
• Accountable for delivering high-quality work.
• Demonstrate Mass General Brigham Health Plan’s core brand principles of always listening, challenging conventions, and providing value.
• Bring fresh ideas forward by listening to and working with employees and the people we serve.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where it’s needed.
• Respect the talent and unique contribution of every individual and treat all people in a fair and equitable manner.
• Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
• Be accountable for delivering high-quality work. Act with a clear sense of ownership.
• Bring fresh ideas forward by actively listening to and working with employees and the people we serve.