HEDIS Abstractor II (Temporary)

Salary Range:  $77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Healthcare Effectiveness Data and Information Set (HEDIS) Abstractor II reviews medical records to ensure completeness, compliance with National Committee for Quality Assurance (NCQA), California Department of Health Care Services (DHCS) and other regulatory agencies. Abstracts medical record information and enters data on appropriate HEDIS forms (tool). Makes determinations regarding compliance on records and refers records to supervisor for clarification when needed. Overreads record review performed by Medical Record vendor for accuracy and researches possible additional records to close HEDIS gaps. Conducts audits and provides HEDIS education at provider offices and provides feedback to office staff and providers on documentation, medical record coding, preventative services, member satisfaction.

Duties

Reviews medical records to ensure completeness, compliance with NCQA, DHCS and other regulatory requirements. Ensure records are complete and compliant to meet all regulatory requirements with 100% accuracy.

Abstracts medical record information and enters data on HEDIS forms (tool) and over reads medical record review performed by vendors. All received medical record information is abstracted and entered accurately on HEDIS forms. Abstracts an average of 100 records or more per day for multiple measures. Works with other staff members to complete the HEDIS project within the time frame for submission to the auditor, NCQA, and regulatory agencies.

Identifies compliance issues on records and refers records to supervisor for clarification and approval.

Responsible for accurate and prompt medical record decisions.

May support schedulers by contacting plan partners or providers for additional information if necessary.

Works with schedulers to help them better understand the medical record requests. Speaks with the office staff/manager/provider to clarify the medical record request as necessary.

Supports the Lead Medical Record by conducting over reads. Overreads medical record abstractions accurately and documents results in the tools provided in the time frame necessary for reporting HEDIS results. Assists with the preparation of de-identifying records for the audit process.

Conducts HEDIS audits at provider sites. Abstracts and calculates findings of 100 or more records from the provider office; meets with the office staff, provider to discuss findings; makes appropriate recommendations to improve documentation and data submission pertinent to HEDIS.

Performs other duties as assigned.

Duties Continued

Education Required

Bachelor's Degree in Health Science or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Experience

Required:
A minimum of 3 years of experience in HEDIS abstraction and/or other Quality Improvement, Quality Management experience in a managed healthcare setting.

Preferred:
Experience in outpatient clinic or hospital setting with three years of HEDIS abstraction training in HEDIS measures pertinent to Medicare and Medi-Cal.

Skills

Required:
Strong background in medical terminology, anatomy and physiology.

Proficient in Microsoft Office (Excel, Word and Outlook).

Strong communications skills: written, verbal, and interpersonal.

Understanding of Health Insurance Portability and Accountability Act (HIPAA); Ability to abide by strict confidentiality regulations as defined by HIPAA and company policy.

Working knowledge of the health record, computer system, and data integrity/processing techniques.

Must be able to work with providers on documentation and coding.

Licenses/Certifications Required

Licenses/Certifications Preferred

Medical Coding CertificationAccredited Health Information Technician (AHIA)

Required Training

Physical Requirements

Light

Additional Information

Financial Impact: Additional position required due to the impact that the Medicare Star program and Medi-Cal auto-assignment program has on the organization.

Required:
Travel to offsite locations for work.

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.  The range is subject to change.

L.A. Care offers a wide range of benefits including

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)

Nearest Major Market: Los Angeles
Job Segment: Medical Coding, Medicare, Physiology, Healthcare