AmeriHealth Caritas Coordinator, HEDIS Non Clinical in Philadelphia, Pennsylvania

Coordinator, HEDIS Non Clinical

Location: Philadelphia, PA

Telecommuter?: Yes

ID**: 14273

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us atwww.amerihealthcaritas.com.

Responsibilities:

Under the direction of the Lead HEDIS Reviewer the HEDIS Coordinator is responsible for:

  • Will participate in and provide guidance and support for the development and maintenance of the HEDIS Medical Record Review platform(s) to support all plans.

  • Coordinate the ongoing Medical Record collection and archiving of documents that support the Medical Record Review Projects, regulatory audits and accreditation standards.

  • Work collaboratively with the Manager, HEDIS to maintain the Department SharePoint site, drives, medical records, blogs, newsletters and other program materials as deemed necessary.

  • Participate in and provide support for process improvement initiatives with the medical record review process across the enterprise.

  • Maintain provider outreach to support HEDIS and MRR projects to include but not limited to: Validation of fax numbers, provider office locations, HEDIS contact information, scheduling of onsite retrieval appointments; maintenance and follow-up for pull lists and investigation into further needed documentation.

  • File copy company invoices, print pull list from MRR tool and save to plan drive.

  • Pull incoming medical records from the fax and copy queues and save to the appropriate plan drive in the designated measurement folders.

  • Scan all incoming medical records received via from mail or onsite visit to the appropriate plan drive in the designated measurement folders.

  • Performs and applies structured auditing abstraction criteria to medical records to determine compliance CIS, IMA, CBP, CCS or other measures as deemed necessary.

  • Maintain an abstraction proficiency rate of 98% by correctly reading, interpreting, and abstracting various components of the medical record such as notes, consultations, medication forms, treatment plans, health history, interval history, and past history.

  • Work on designated projects assigned and deemed as necessary.

  • Ability to analyze data including statistical analyses. Ability to analyze practices, identify trends and make recommendations for improvement of practice and processes related to Medical Record Retrieval and HEDIS. Recommends and implements program improvements that strengthen the MRR process and be able to present in a written report.

  • Review Roadmap for accuracy General Information, Appendix 1, and Section 4.

Education/Experience:

  • High School/GED required; Associates degree preferred

  • 1-3 years demonstrated expertise in project coordination, office management, medical record collection, medical terminology, call center, creating and managing central data repositories and data management systems for an office or large department.

  • Knowledge of medical terminology and basic charting.

  • Experience with Microsoft Publisher, Visio, Excel, Power Point, Share Point.

  • Able to think and work effectively under pressure.

  • The ability to function effectively within multidisciplinary teams.

  • Ability to accurately complete tasks within established times.

  • Ability to effectively prioritize multiple tasks and deadlines.

EOE Minorities/Females/Protected Veterans/Disabled