QM Operations Clerk

Job Title: QM Operations Clerk
Job Location: New York, NY
Job Duration: 1-2 Months (possibility of extension)
Shift: 9:00am - 5:00pm In person/Hybrid
Payrate: $20/hr - $24.00/hr. on w2

Job Summary:

• The primary function of the QM Operations Clerk – Seasonal is to provide administrative and technical support for the annual Medical Record Review (MRR) project required for reporting HEDIS/QARR measures to the New York State Department of Health (NYS DOH) and the client.
• This is a field-based, seasonal position running approximately seven months (November of the measurement year through May of the reporting year).
• The role involves processing medical charts received through multiple channels (fax, mail, email, and onsite abstraction), coordinating with provider offices, and ensuring data accuracy and system synchronization.
• The position may also require onsite abstraction of medical charts at provider offices throughout the client five boroughs.

Product of Role & Responsibilities:

• Maintain working knowledge of medical record review processes and Electronic Medical Record (EMR) systems.
• Demonstrate proficiency in Microsoft Office applications, scanning, and accurate data entry into systems.
• Process incoming medical charts via email, fax, and mail.
• Accurately document receipt of records in appropriate systems according to established documentation standards.
• Ensure data integrity and continuity of member services over time.
• Distribute medical record requests and schedule onsite retrieval appointments with provider offices.
• Conduct telephonic outreach to providers for scheduling onsite visits and following up on outstanding medical record requests.
• Perform medical chart abstraction through EMR systems, in-house paper records, and onsite provider office visits.
• Ensure chart retrieval goals are met within internal timelines and regulatory requirements.

Required Education, Training & Professional Experience:

• High School Diploma or GED.
• Minimum of two (2) years of relevant work experience in managed care, health plan, or provider office setting.
• Proficiency in Microsoft Office Suite, including Word, Excel, PowerPoint, and Access.
• Proficiency in Adobe Acrobat Pro (file extraction, splitting, and combining).
• Quality Assurance experience in a managed care setting preferred.

Professional Competencies:

• Integrity and Trust.
• Customer Focus.
• Functional and Technical Skills.
• Strong Written and Oral Communication Skills.

Skills:

• One year experience required.
• Ability to travel within the service area.

Schedule Hours Per Week: 40.00
Schedule Hours Per Day: 8.00
Schedule Days Per Week: 5.00