Quality Abstraction & Clinical Reviewer
Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world class doctor close to where they live.
The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.
Position Purpose: The Quality Abstraction & Clinical Data Reviewer is integral to the success of Steward in value-based contracts that often require extensive reporting of clinical information for quality performance evaluation purposes. This position will review medical records and translate the clinical information to into quality reporting data through data entry into the performance tools used by Steward that will then be submitted to the Center for Medicare and Medicaid Services, MassHealth, as well as other contractual oversight teams and regulatory bodies. Being successful in this role requires careful review of measure instructions and ability to become a subject matter expert on all applicable quality measure instructions. Candidates should also be able to generate clear and concise questions to resolve ambiguity in measure instructions and apply guidance released from measure stewards on how to report complete and accurate quality measure performance.
- Audits medical records with a 98% accuracy rate per HEDIS or other performance measures and technical specifications; documents findings in electronic tools; meets project productivity goals.
- Researches claims, enrollment, and other sources of data received by Steward to locate reportable clinical information for quality measures.
- Organizes and executes outreach activities to retrieve medical records required for quality reporting projects (mailings, text messaging, newsletters, etc.)
- Partners closely with team members to keep projects on track at all times, serves as main point of contact for vendors when assigned, checks accuracy and completeness of vendor’s work, creates outreach lists from electronic tools and transmits them to vendors, documents activities in electronic tool.
- Prepare and submit accurate productivity and project reports.
- Other duties as assigned based on business need
Education / Experience / Other Requirements
- LPN, RHIT, CPHQ, certified medical coder; CCS, CCS-P, CDEO, CPMA, CPC, CRC, CHCA or similar credential preferred
Years of Experience:
- Four (4) or more years of work experience in a health care quality or medical coding role; with
- Two (2) or more years of experience in auditing medical records against specific quality performance technical specifications
- Computer skills, i.e., using various software, including intermediate Excel skills (sort, filter, reformat data, etc.)
- Successful experience implementing and overseeing completion of long-term assignments
- Self-directed, ability to thrive in a fast-paced, paper-free environment
- Comprehensive knowledge of computers and software such as Microsoft Windows, Windows Explorer, Outlook, Excel, Word, Google Chrome, PDF file creation and conversion
- Ability to learn basic working skills with new software in short timeframes
- Strong oral, phone and written communication skills
- Strong knowledge of health information privacy and security rules and regulations
- Ability to effectively interact with people when meeting for the first time
- Ability to adapt to new surroundings and changing office environments
- Establish positive and professional relationships with care provider offices, clinics, hospitals, other clinical facilities and Steward Health Care Network staff
Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.
Steward Health Care Network is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment – with confidence and without fear.
Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience:
- Any COVID-19 related care takes place in designated areas away from other patients and their families.
- A stringent cleaning policy has been implemented throughout our facilities.
- A strictly controlled visitor and masking policy is required for patient and colleague safety.
You can rest assured that we have made the necessary preparations to provide care in a safe, controlled and professional way.