QM Operations Clerk

PR range:

• $20-$21/hr. on w2

Schedule Notes:
9-5 Hybrid
High School/GED with a minimum of two years relevant work experience in a managed care, health plan or provider office setting.
Proficient in Microsoft Office applications including Word, Excel, PowerPoint and Access.
Proficient in Adobe Pro for file extracting, splitting and combining.
Quality Assurance experience in a Managed Care Setting preferred.

Duties:

Position Overview:
The primary function of the QM Operations Clerk - Seasonal is to function as administrative and technical support of the annual Medical Record Review project required to report HEDIS/QARR measures to the NYS Department of Health and Centers for Medicare & Medicaid Services (CMS). The role is field-based and seasonal (November of the measurement year through May of the reporting year), approximately seven months.

The position will be responsible for processing incoming medical charts via multiple methods (fax, mail, email, onsite abstraction) and ensuring all systems are synchronized. The role requires a technically savvy individual who can multi-task accurately while conducting telephonic outreach to providers to schedule onsite retrieval, follow up on requests for medical charts and process incoming documents. The person may also be required to conduct onsite abstraction of medical charts in provider offices throughout the NYC area.

The position may require travel within the five boroughs.
Product of Role & Responsibilities:

• Maintain knowledge of medical record review and EMR systems.

• Proficiency in MS Office applications, scanning and accurate data entry into MetroPlus Health Plan systems

• Process incoming medical charts via email, fax, mail. Data enter receipt in the appropriate system(s) in accordance with established documentation standards for MetroPlus Health Plan to ensure integrity of member services provided over the continuum of care and over time.

• Distribute requests for records and schedule appointments with provider offices to ensure timely completion of duties to meet internal and regulatory standards and requirements. Conduct follow-up of medical chart requests with provider offices to ensure the chart retrieval goal is met

• Perform abstraction via EMR, in-house paper medical records, on-site provider visits to collect documentation of measure compliance.

Required Education, Training & Professional Experience:

• High School/GED with a minimum of two years relevant work experience in a managed care, health plan or provider office setting.
• Proficient in Microsoft Office applications including Word, Excel, PowerPoint and Access.
• Proficient in Adobe Pro for file extracting, splitting and combining.

• Quality Assurance experience in a Managed Care Setting preferred.

Licensure and/or Certification Required:

• n/a

Professional Competencies:

• Integrity and Trust
• Customer Focus
• Functional/Technical Skills
• Written/Oral Communications

Skills:
One year experience required

Schedule Start Date:
09/30/2024

Schedule Start Date:
09/30/2024

Schedule Hours Per Week:
40.00

Schedule Hours Per Day:
8.00

Schedule Days Per Week:
5.00