Overreader, Hedis/quality Improvement - Long Beach, United States - Molina Healthcare

Molina Healthcare
Molina Healthcare
Verified Company
Long Beach, United States

4 weeks ago

Mark Lane

Posted by:

Mark Lane

beBee recruiter
Description
Job Description

Job Summary


Molina's Quality Improvement Overread conducts oversight and audits of the data collected and abstracted from medical records for HEDIS projects, HEDIS like projects and supplemental data collection.

The overreader team will meet chart overread productivity standards, minimum over read standards, and 2nd overread standards to ensure accuracy of their audit skills.

Job Duties


Performs the role of the HEDIS medical record review overreader/auditor which includes ongoing review of records reviewed and data entered by the abstraction team during the annual HEDIS medical record review as well as all other HEDIS/HEDIS like project.


Participates in scheduled meetings with the Abstraction team, National Training Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results.

Provides feedback to providers on visit notes or feedback from the HEDIS audit. Makes recommendations based off of the audit and chart review.

Job Qualifications


REQU I RED ED U C A TI O N:
Bachelor's degree or equivalent experience


REQU I RED E X PE R I E N C E/KNOWLEDGE, SKILLS & ABILITIES:

  • 3 years experience in healthcare Quality/HEDIS specific to medical record review and abstraction

PR E FE R RED E X PE R I E N C E:
At least 3 years of medical record abstraction experience

3+ years managed care experience.

Advanced knowledge of HEDIS and NCQA

PR E FE R RED L I C E N S E, C E R TI FI C A T I O N, AS S O C I A TI O N:
Active RN license for the State(s) of employment


PHY S I C AL DEM A N D S:

W o rki n g en v i r o nm ent is g e n erally f a vo r a b le and li gh t i n g and t e m p erature are a d eq u at e.

W o rk is g eneral l y p erf o r m ed in an o ff i ce e n v i r o n m ent in w h i c h t h ere is o n l y m i n i m al e x p o su r e to u np leasa n t a nd /o r ha z ar d o u s w o rki n g c o nd iti o n s.

M u s t h a v e t h e a b ility t o s i t f o r l o n g p eri o d s.

Rea s o n a b le acc om mo d a ti o n s m a y be m a d e to e n a b le in d i v i du als with d i sa b ilities t o p er f o r m t h e e ssential fu n cti o n.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range:
$ $42.55 / HOURLY

  • Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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