One of the largest health insurers in the nation is focused on continuously building an industry-defining, world-class IT capability. Healthcare is forever evolving, especially due to emerging technologies, making this a great experience to add to your resume. Come join their winning team.
This contract to hire role as a Quality Audit Specialist in Chicago, IL 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.
Pay Rate: $40 - $54 per hour
Responsibilities:
• 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
• Overseeing and reviewing 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.
• Impacting the integrity of the Medical Record validation process and HealthCare Effective Data & Information Set (HEDIS) Reporting.
• Contributing toward the achievement to maintenance of accreditation with national accreditation agencies.
Job Requirements:
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.
Benefits:
Solving IT, a Woman and LGBTQ+ owned and operated organization is thrilled to provide a comprehensive benefit package to all our W2 employees and their families, regardless of gender. We are proud to offer five diverse health plan options as well as a PPO dental plan through Blue Cross Blue Shield, Term Life/AD&D Insurance, and a 401(k) Savings Plan. Solving IT covers a portion of the health and dental premiums for our employees.
As you progress in your professional journey, Solving IT is dedicated to accommodating your evolving preferences and matching you with fulfilling projects. We champion equality and embrace diversity in all its forms. Creating an atmosphere that encourages varied perspectives to collaborate fosters personal development, strengthens team unity, and contributes to the overall success of the organization.
Whether you're seeking your next career challenge or aiming to stay abreast of industry trends, Solving IT is committed to supporting your career advancement. We actively encourage applications from all backgrounds and utilize the most up-to-date market insights and compensation data to ensure that you receive not just advice, but the complete Solving IT Experience.