Clinical Specialist

Pay: $47.50/hr on W2or $95k conversion salary

This position is responsible for ensuring the audit and review of electronic clinical records to ensure they accurately reflect medical record documentation to meet regulatory and accrediting compliance mandates. This position will be responsible for oversight and review of the abstraction/extraction process of clinical data from Electronic Medical Records (EMRs); auditing supplemental files supplied by providers and vendors for HEDIS, Quality Rating System (QRS) and other quality measures;

identifying areas of opportunity to improve documentation and audit outcomes. This position impacts the integrity of the Medical Record validation process and Health Care Effective Data & Information Set (HEDIS) Reporting. In addition, this position significantly contributes toward the achievement to maintenance of accreditation with national accreditation agencies.

Individual must demonstrate strong multi-tasking setting priorities based upon minimal direction including:

• Understanding of NCQA HEDIS quality measures and code value sets.
• Conducts clinical validation on incoming supplemental data files.
• Maintains standard operating procedures (SOPs), user guides to reflect accurate and updated processes
• Educates internal and external stakeholders (e.g., providers, vendors) in supplemental processes
• Supports clinical validation during the onboarding process including primary source verification (PSV) during official/mock audits.
• Conducts analysis and investigation on inquiries related to medical records data collection tied to technical specifications
• Collaborates with technical staff in performing research and assist in data analysis
• Maintains productivity level with less than a 5% error rate in record abstraction and data entry on an ongoing basis.
• Strong proficiency with tools, language MS Office Suite: MS Word, MS Excel, MS PowerPoint, and MS SharePoint.
• Familiar with HIX (Health Insurance Exchange), EMR (Electronic Medical Record), EHR (Electronic Health Record) types of data collection.
• Apply structured auditing criteria to abstract medical records, follow defined procedures for saving approved medical record documentation and accurately enter the results of chart audits
• Maintain complete confidentiality of company related business.
• Maintain effective communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.