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) Work Location: Remote Apply tot his job Apply To this Job