Medical Record Reviewer, full-time (remote)
Company: Partners Healthcare
Location: Somerville
Posted on: June 12, 2022
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Job Description:
For over 30 years, AllWays Health Partners has delivered value
to our members and worked to improve access to care and coverage.
As a member of Mass General Brigham, AllWays is a health plan at
the forefront of innovation, advancing a highly integrated model of
value-based care with one of the world's leading health care
systems. Together, we are transforming the customer experience,
keeping our members and patients at the center of everything we do.
Bring your unique talents and join us as we strive to create a
world where all people live healthier lives. The Medical Record
Reviewer carries out key initiatives related to reporting and
improving HEDIS for AllWays Health Partners. The primary
responsibility of this position will be managing the HEDIS medical
records review project including coordination of medical records
data collection and chart reviewing. This position will facilitate
appropriate medical records data collection for the EQRO (External
Quality Review Organization) auditing and all other medical records
review, such as medical records document standards review and also
facilitate collection of race/ethnicity and language data from PCP
practice sites. Essential Functions --- Manages relationship with
provider sites to collect data for HEDIS, EQRO, NCQA, and
race/ethnicity and primary language data for various projects in
AllWays Health Partner --- Manages medical record review process
that include o Managing a training program for abstraction of the
necessary medical record o Coordinating scheduling and staffing of
on-site reviews at PCP practice sites and hospital o Conducting
periodic over-reads for contract reviewer o Revising and updating
HEDIS medical record review tools to reflect specification change o
Monitoring completion and compliance rates during the HEDIS
reporting period o Securing successful medical record review o
Completing the HEDIS roadmap document --- Supports the submission
of final HEDIS results to our auditors, NCQA and the state Medicaid
office. --- Coordinates the medical records documentation standards
review process that include o Revising and updating review tool o
Selecting sites for review based on AllWays Health Partners policy
o Performing onsite review o Tabulating and disseminating review
result o Providing technical assistance for documentation
improvement to site --- Hold self and others accountable to meet
commitments. --- Ensure diversity, equity, and inclusion are
integrated as a guiding principle. --- Persist in accomplishing
objectives to consistently achieve results despite any obstacles
and setbacks that arise. --- Build strong relationships and
infrastructures that designate AllWays Health Partners as a
people-first organization. --- Contributes to cross-functional
projects led by other departments, where appropriate. --- Performs
other duties and staff work as assigned with or without
accommodation as required. --- Other duties as assigned with or
without accommodation. Working Conditions and Physical Effort ---
This is a remote position with an occasional need to go into the
office for meetings or training Qualifications Knowledge and
Education Required: --- Bachelor's Degree or the equivalent
combination of training and experience, plus 3 years of medical
records review experience. --- Must be an RN, LPN, Certified Coder,
RHIT, RHIA, MA or Medical Records professional Preferred/Desired:
--- Have a history of successfully coordinating a HEDIS medical
record review project --- RN Preferred Experience Strongly
Preferred/Desired: --- 3 years of medical record review experience
--- Have a history of successfully completed HEDIS medical record
review --- Be able to work collaboratively with staff throughout
the organization --- Ability to use HEDIS medical records review
tool and to manipulate data in Excel and/or Acce --- Ability to
manage competing deadlines and handle multiple tasks simultaneously
--- Excellent verbal and written skill --- Project and budget
management experience Skills/Competencies --- Respects the talent
and unique contribution of every individual, culture and ethnic
group and treats all people in a fair and equitable manner. ---
Exercises self-awareness; monitors impact on others; is receptive
to and seeks out feedback; uses self-discipline to adjust to
feedback. --- Accountable for delivering high quality work. ---
Demonstrate AllWays Health Partners' core brand principles of
always listening, challenging conventions, and providing value. ---
Bring fresh ideas forward by listening to and working with
employees and the people we serve. --- Strong aptitude for
technology-based solutions. --- Ability to inject energy, when and
where it's needed. --- Respect the talent and unique contribution
of every individual, and treat all people in a fair and equitable
manner. --- Exercise self-awareness; monitor impact on others; be
receptive to and seek out feedback; use self-discipline to adjust
to feedback. --- Be accountable for delivering high-quality work.
Act with a clear sense of ownership. --- Bring fresh ideas forward
by actively listening to and working with employees and the people
we serve. Organizational Relationships/Scope Interaction with all
levels of employees within AllWays Health Partners. May have some
interaction with external organizations related to HEDIS. EEO
Statement Our promise as a people-first organization starts with
our employees. AllWays Health Partners is committed to diversity,
equity, and inclusion in our workforce, internal culture, and
investments. As an equal opportunity employer, AllWays Health
Partners recognizes the power of a diverse community and encourages
applications from individuals with varied experiences,
perspectives, and backgrounds. Disclaimer The above statements are
intended to describe the general nature and complexity of the work
being performed by personnel assigned to this classification and do
not represent an exhaustive list of all tasks, duties, and
responsibilities required of personnel assigned to this
position.
Keywords: Partners Healthcare, Somerville , Medical Record Reviewer, full-time (remote), Accounting, Auditing , Somerville, Massachusetts
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