Job Description
Job Description
JOB RESPONSIBILITIES
- Annually report Healthcare Effectiveness Data and Information Set (HEDIS) and Risk Adjustment.
- Apply structured auditing criteria to abstract medical records, follow defined procedures for saving approved medical record documentation and accurately enter the results of chart audits into the health plans database, Quality Spectrum Hybrid Reporter (QSHR).
- Abstract medical record documentation submitted for HEDIS measures, used annually for reporting to National Committee for Quality Assurance (NCQA). The HEDIS measures are used to assist in measuring quality of health care provided to health plan members.
- Maintains productivity level with less than a 5% error rate in record abstraction and data entry on an ongoing basis.
- 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 regarding development within areas of assigned responsibilities and perform special projects as required or requested.
QUALIFICATIONS:
- Bachelors' Degree, Risk Coding or relevant experience.
- 7+ years relevant experience.
- Experience in utilization review, quality assurance, and/or medical record and site review audits.
- Knowledge of medical terminology standard medical practices, formal quality improvement process, and federal, state, accreditation regulations and standards.
- Verbal and written communications skills including interpersonal skills for meeting with physicians and office staff and representing the company using diplomatic/professional demeanor.
- PC proficiency to include Word and Excel.
- HEDIS and/or Risk Adjustment Experience highly preferred.
Company Description
W3R Consulting is a Southfield, Michigan based staffing and consulting firm that provides talent, technology consulting and advanced analytics solutions to Fortune 500 companies in the automotive, financial, healthcare, insurance, professional and business services, and retail industries. In 2012, w3r acquired Nurse Now Staffing. inner of numerous customer and industry awards, this year W3R celebrates 22 years of innovation, exceptional customer service and community engagement.
Company Description
W3R Consulting is a Southfield, Michigan based staffing and consulting firm that provides talent, technology consulting and advanced analytics solutions to Fortune 500 companies in the automotive, financial, healthcare, insurance, professional and business services, and retail industries. In 2012, w3r acquired Nurse Now Staffing. inner of numerous customer and industry awards, this year W3R celebrates 22 years of innovation, exceptional customer service and community engagement.