Medical Record Reviewer, full-time (remote)

Company: Partners Healthcare
Location: Somerville
Posted on: June 12, 2022

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