POSITION PURPOSE: Provides ongoing VBS/HEDIS medical record collection and abstraction; and supports the abstraction of medical records related to VBS/HEDIS Compliance initiatives. Provides accurate assessment of provider performance against VBS/HEDIS standards and procedures. Adheres to strict HIPAA confidentiality requirements for protected health information. Works under general supervision.

POSITION REQUIREMENTS / QUALIFICATIONS:

Education/Experience: Graduate from a Standard High School or GED Equivalent. Graduate from an approved Medical Coding Program, Medical Assisting program preferred.

Licensure / Certification: Maintain current CPR certification from the American Heart Association. MA certification or coding certification desired

Skills / Ability: Medical Terminology, Keyboard, Knowledge of Medicare, Medicaid, and Managed Care coverage benefits/limitations, NCQA HEDIS requirements. Knowledge of ICD9 and CPT Coding. Basic computer knowledge is preferred. Bilingual in English/Spanish preferred.

POSITION RESPONSIBLITIES (THIS IS A NON-EXEMPT POSITION):

 Performing accurate and comprehensive reviews of medical records for HEDIS measures.

 Auditing high volumes of medical records to ensure correct and appropriate code assignment.

 Ability to multitask and troubleshoot problems independently.

 Ensuring accurate data entry for claim submission.

 Medical record review, data abstraction, and quality experience.

 Schedule appointments with health care provider including appointments to PCP for their health risk assessments, preventative visits and chronic care management.

 Participate in Performance Improvement Activities.

 Participate in appropriate continuing education in service training.

 Maintain current licensure and/or certificates.

 Ability to read and interpret medical documents.

 Ability to prioritize, multi-task, and achieve goals on time; work independently and to self-motivate.

 Strong data entry skills; capable of using a computer efficiently and effectively.

 Able to navigate and master practice management and EHR software programs.

 Treat clients, team members and the public with courtesy, respect and present a positive public image.

 High production environment and, candidates must adhere to measured productivity requirements.

 Ensuring adherence to NCQA HEDIS guidelines.

 Research medical history to determine the most appropriate and source of necessary documentation.

 Based on a strong knowledge of HEDIS criteria, identify the medical information that supports the specific HEDIS measure.

 Responsible for obtaining, organizing, and securing a large volume of medical records within a limited timeframe.

 Adhere to department Policies and Procedures in performing duties and assignments.

 Demonstrates the ability to work with a diverse population.

 Ability to post appropriate CPT Category II Performance Measure codes after chart review and audit.

 Reports to work on time and ready to work with minimal absenteeism.

 Adheres to Confidentiality Policies and Procedures / HIPAA Regulations.

 Well organized with the ability to maintain attention to detail.

 Ability to work independently and as a team member.

 Maintains productivity standard of reviewing 60 medical records daily.

 Performs other duties as assigned.