Medical Record Review Auditor

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer.
All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve.
We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.
Temporary contract position to review medical charts.
Medical records will be reviewed to find documentation and compliance for HEDIS performance measures.
Data elements being sought are laboratory results, blood pressures, body mass index, colon cancer screening, and other aspects of care.
Summary: Medical records will be reviewed to find documentation and compliance for HEDIS performance measures.
Data elements being sought are laboratory results, blood pressures, body mass index, colon cancer screening, and other aspects of care.
Essential Responsibilities: The auditor will review medical records obtained by a vendor and available electronically at the PacificSource office.
The medical record review on the members in the population will be performed according to NCQA HEDIS specifications.
Data will be entered using certified HEDIS software on laptop computer after training has been completed.
The medical record will be reviewed for confirmation of member identification, data elements, numerator events and exclusions per HEDIS specifications outlined on MRR tools in the certified software system.
Numerator events and exclusions will be documented in the software program and by photocopying, printing, or capturing a digital image of the page of the medical record where the event or contraindication is found.
Ability to audit with 95% accuracy.
Protect PHI by never leaving laptop in car.
Always lock computer when leaving its location.
Do not reveal passwords.
Do not discuss PHI with anyone who does not have a legal need to know.
All photocopied medical records will be handled according to the health plan confidentiality and safe guarding PHI policy and procedure.
Supporting Responsibilities: Meet department and company performance and attendance expectations.
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.
SUCCESS PROFILE Work Experience: Acute care experience or experience in a primary care clinic or experience with disease management.
Experience using or viewing electronic medical records.
Experience performing chart audits preferred.
Education, Certificates, Licenses: Valid nursing license (RN or LPN).
Competencies: Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work remotely and occasional inside a general office setting with ergonomically configured equipment.
Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Our Values We live and breathe our values.
In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for customer service.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend.
Sit and/or stand for extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing.
Light lifting and carrying of files and business materials.
Ability to read and comprehend both written and spoken English.
Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change.
It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position.
Employment remains AT-WILL at all times.