POPULATION HEALTH COMPLIANCE TECHNICIAN
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.
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.