HEDIS Medical Record Reviewer (MRR)
Basic Job Info
At least 2 year(s)
Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California’s Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.
We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.
Primary responsibility will be to over read and to perform medical record abstraction, & enter findings into abstraction tool (Inovalon QSHR). Identify chase opportunities & track progress. Coordinate with Program Manager, and administrative staff to manage caseload for teams. Communicate with team members to effectively manage project assignment. Communicate with healthcare providers.
Specific tools and tasks which will be relevant for this position:
Uses automated office equipment such as a computer and specific applications and tools for HEDIS, including Inovalon QSHR, Right Fax, Adobe Standard and Microsoft Office Suite.
Will communicate verbally and in writing with both the internal team as well as provider offices.
Will oversee and maintain a system to organize the medical records and other materials/ resources which are required for the overall MRR processes to work and flow effectively.
Other duties as assigned.
Level of Responsibility:
Responsible for assignments that are complex in nature where considerable judgment and initiative are required in resolving problems and making recommendations.
Acts independently to determine methods and procedures on new assignments
May oversee the activities of other nonexempt and temporary personnel.
Provides orientation and training to lower level employees.
Minimum Qualification and Experience Level:
RN, LVN/LPN or certified coder
Minimum with previous 2 years of on-season HEDIS Medical Record Review experience
Must be proficient in computers and conducting most/all work activities on computer only
Ability to read and navigate clinical medical records in looking for specifically sought information
Strong attention to detail and accuracy is essential
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
: Quality Assurance (NUR)
: United States of America-California-El Segundo
: Health Care Quality & Affordability
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