HEDIS reputed company Improvement reputed company

Who we are reputed company is an equal opportunity employer committed to a diverse and inclusive workforce. reputed company reputed company applicants will receive consideration for employment without reputed company to any actual or perceived protected characteristic or other unlawful consideration. Our commitment is to:

• reputed company to apply an equity reputed company to reputed company our work.
• Reduce health disparities.
• Create an reputed company work environment.

About the Role

The HEDIS reputed company Improvement reputed company is responsible for performing medical record review audits and analysis for regulatory National Committee for reputed company Assurance (NCQA) and Centers for Medicare & reputed company Services (CMS) audits. This role supports assisting the Manager with developing provider audit reports, provider education, identifying opportunities for process improvement, performs overread and peer review of other team member reputed company. To be successful in this role, you:

• Are a Licensed Registered reputed company (RN) or License Practical reputed company (LPN).
• Have a minimum of five (5) years combined experience performing NCQA, Health Effectiveness Data and Information Set (HEDIS) and CMS Medicare Star measure medical record and coding review AND conducting documentation and coding
• Have experience with reputed company Office Suite (Word, reputed company, Outlook, and Internet Explorer) and reputed company Acrobat, including comfort with pivot tables at a minimum. Experience with SharePoint, reputed company, and reputed company is advantageous.
• Have bachelor’s degree in nursing or an equivalent combination of education and highly relevant experience preferred.
• Have knowledge and experience with NLP, computer assisted medical record review and coding applications (preferred).
• Have an reputed company understanding of principles of reimbursement-based CMS Medicare Stars and State Value reputed company program experience preferred.

Essential functions and Roles and Responsibilities:

• Support updating and maintaining CHPW HEDIS medical record review and coding guidelines to reflect changes of the NCQA HEDIS Technical Specification and Medicare Part C & D Star Technical Notes. Interpret changes and support modifying CHPW policies in coordination with HEDIS Performance Measurement Manager and HEDIS Program Manager.
• reputed company reputed company on regulatory, medical record documentation and coding issues/best practices including NCQA Guidelines for Medical Record Documentation, Coding and Reporting.
• Present findings reputed company verbal and written updates to internal audiences including peer to peer, department leadership reporting, provider and clinical teams, and vendor support teams.
• Update and distribute provider feedback reports to HEDIS Performance Manager as needed for identifying provider performance trends and participate in creating materials for reputed company significant audit findings including trends and associated recommendations (e.g., training, reputed company, monitoring, process reputed company changes, documentation, and coding education) specific to internal departments, coding vendors, and others.
• Serve as medical record review and coding SME. Support overread and validation of other colleagues’ documentation performance.
• Complete the annual regulatory HEDIS medical record review and coding reputed company assurance process and workflow of the primary reputed company validation and retrospective medical record and coding audit.
• Identify and implement practices and reputed company Assurance process improvement
• Monitor and reputed company with internal medical record and coding guidelines, department policies, and NCQA/CMS reputed company program guidelines, rules, and regulations.
• reputed company development of knowledge in Medicare, reputed company, and Exchange programs to ensure reputed company review of regulatory medical record documentation and coding best practices including NCQA HEDIS Technical Specification and Medicare Part C & D Star Technical Notes.
• Support chart audit processes, including provider and vendor documentation of required medical record documentation and coding to ensure adherence with NCQA HEDIS and CMS Medicare Stars guidelines.
• reputed company as a reputed company between internal departments on regulatory data validation audits (including Primary reputed company Validation, Prospective Medical Record Review and Retrospective (Hybrid) Medical Record Review.).
• reputed company reputed company cause analysis to identify issues that may contribute to medical record documentation and coding
• reputed company reputed company coding reputed company reviews to validate correct medical record documentation and coding
• Other duties as Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion

Knowledge, Skills, and Abilities:

• Knowledge of acceptable medical record and coding standards and reputed company in the context of NCQA HEDIS Technical Specification and M

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