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Job Requirements of Health Care QM Analyst:
-
Employment Type:
Contractor
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Location:
Rhode Island, US (Onsite)
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Health Care QM Analyst
Careers Integrated Resources Inc
Rhode Island, US (Onsite)
Contractor
Job Title: Health Care QM Analyst
Job Location: Please note: Actual location may vary, IR
Job Duration: 5-6 Months (possibility of extension)
Payrate: $26.73/ hr on W2
Job Summary:
Job Location: Please note: Actual location may vary, IR
Job Duration: 5-6 Months (possibility of extension)
Payrate: $26.73/ hr on W2
Job Summary:
- The Coordinator III - HEDIS Outreach Coordinator will work directly with other coordinators to ensure quality of work delivered, performance/productivity benchmarks are met, and all compliance related issues are properly addressed, trained and coached on a consistent basis.
- The Medical Record Coordinator will work directly with each assigned market Senior Manager and will be responsible for requesting, reviewing, analyzing, and validating medical records to ensure compliance with regulatory requirements, quality improvement initiatives, and HEDIS and risk adjustment measures.
- This role supports the MCO’s efforts to enhance healthcare quality, accuracy in reporting, and compliance in the medical record review processes.
- Review and extract key clinical data from member medical records for quality reporting and compliance.
- Ensure completeness, accuracy, and consistency of medical documentation.
- Identify missing or incomplete documentation that may affect the medical record review standards.
- Support coordination with provider offices to obtain medical records.
- Assist in preparing final report/scorecards on medical records review trends, discrepancies, and areas of improvement.
- Experience/knowledge of reading/reviewing medical records, including within EMR systems
- Minimum 1-3 years or more experience with medical record review, chart abstraction, or clinical documentation improvement.
- Strong attention to detail
- Ability to critically analyze documentation for accuracy, completeness, and compliance with medical record standards.
- Experience in identifying documentation gaps and inconsistency that impact the medical record standards
- Excellent communication and organizational skills
- Comfortable in both team player and team lead roles
- Confident in decision making ability within strict timelines
- Exceptional prioritization skills
- Acts with integrity and uses sound judgment in dealing with confidential information
- LPN/LVN with unrestricted active license or HEDIS abstraction experience.
- Healthcare or similar field preferred and have 2+ years of relevant work experience.
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