Overview
Presbyterian is seeking a talented Quality Improvement Abstractor. The Quality Improvement Abstractor performs the Medical Record Retrieval, Review, and Reporting process to support HEDIS, STARs, HEDIS Like, supplemental, and other required regulatory reporting as well as PHP Board approved health management initiatives across the enterprise. The role assists with ensuring clinical and fiscal improvements and documents service delivery in accordance with Presbyterian Health Plan policies.
Ideal Candidate
LVN/LPN or Certified Coder
Knowledge of medical terminology, standard medical practices, medical assistant, medical coding or data management experience
Management experience
Qualifications
High School Diploma or equivalent
2-3 years healthcare experience
Experience working within Electronic Health Records
Experience with medical terminology, standard medical practices, medical assistant, medical coding or data management experience
Responsibilities
Uses Performance Improvement tools and techniques to develop work plans, tasks, timelines, and measurements for all health management project assignments. Project plans will be developed for all projects and milestones monitored and reported.
Identifies needs, designs valid and reliable tools for data collection, analyzes data, researches data and claims, and provides feedback in an appropriate format. May assist with development and implementation of quality initiatives. Monitors outcomes and quality of services provided.
Performs Medical Record Reviews necessary to support quality initiatives and regulatory reporting, including but not limited to HEDIS reporting, CMS Star measures, FEHB measures, Centennial Care, and supplemental data reporting. May be held to productivity standards as well as minimum over read standards.
Manages an assigned caseload of provider locations and provides verbal and written progress regarding status of each provider’s submission of requested medical records. Excellent communication and facilitation skills are keys to success.
Identifies and analyzes clinical information applying to HEDIS and NCQA requirements. Documents abstracted findings into a HEDIS database tool. Tracks and reports on issues and outcomes related to abstractions and over-reads. Integrates data collected from a variety of electronic and paper sources. Communicates significant findings, including potential risk management issues to the Manager in a timely manner.
Benefits
All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinars, preventive screening and more.
Why Work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services
Presbyterian exists to ensure the patients, members and communities we serve can achieve their best health. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
E-EO Statement
Maximum Offer for this position is up to USD $35.29/Hr. The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.