Medical Records/Quality Control

QI Specialist I

3+ Months

Remote

PR:$37/hr

Job Description: 100% REMOTE BUT MUST RESIDE IN UTAH

Job Description:

Essential Functions:
• Collects HEDIS data and/or Ambulatory Medical Record Review Data through chart review of medical records (medical record abstraction) as directed.
• Supports various HEDIS activities as needed.
• Reviews, identifies and trends quality of care issues, serious reportable adverse conditions and assists in the implementation of corrective action plans.
• Participates in the development of materials as needed for member and provider quality initiatives such as HEDIS, improvement projects, and studies.

Knowledge/Skills/Abilities:
• Proficiency with PC-based systems
• Excellent verbal and written communication skills
• Ability to abide by Client’s policies
• Ability to maintain attendance to support required quality and quantity of work
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

Required Experience:
• 0-2 years experience in Quality Improvement.
• 0-2 years experience in managed care or healthcare industry.
• Experience with qualitative or quantitative projects/analysis.

Required Licensure/Certification: None required. RN/LPN preferred

Must Have Skills:

Knowledge/Skills/Abilities:
• Proficiency with PC-based systems
• Excellent verbal and written communication skills
• Ability to abide by Client’s policies
• Ability to maintain attendance to support required quality and quantity of work
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

Day to Day Responsibilities:
• Contact providers to collect required medical records for RADV audit. May need to go to the clinic location to collect medical records.
• Work collaboratively with other Client departments to secure medical records for audits.
• Collaborates with the Quality Improvement department staff in the development of quality improvement studies, initiatives and projects to improve the health care of members.
• Plans and coordinates the collection, evaluation and dissemination of quality improvement data for quality initiatives, studies and projects to comply with regulatory requirements and accreditation standards.
• Prepares reports and analyses to evaluate performance with standards from a variety of sources such as and not limited to: materials, documents, medical charts, provider offices, and/or facilities.
• Performs with qualitative and quantitative analysis to identify significant and problematic clinical issues and concerns, development of improvement plans and measurement to assess impact of actions.

Job Type: Contract

Pay: $35.00 - $37.00 per hour

Education:
• High school or equivalent (Preferred)

Experience:
• Quality improvement: 5 years (Preferred)
• Healthcare Document Review : 5 years (Preferred)
• Providers data: 5 years (Preferred)
• NCQA: 5 years (Preferred)
• HIPAA: 5 years (Preferred)
• HEDIS: 5 years (Preferred)
• Medical records: 5 years (Preferred)

Location:
• Utah (Required)

Work Location: Remote

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