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Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. 3+ years of experience in HEDIS record collection and risk adjustment (coding.
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The team independently maintains the HEDIS/QARR data repository that informs reporting of HEDIS, QARR, and PCMH data to NYS DOH and CMS. To that end, the team carries the responsibility of ensuring the monthly rates and annual HEDIS and QARR submissions are timely, and quality checked for accuracy and completion.
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Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.
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Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards.
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Provide educational support to physicians and staff to ensure process improvement and increase member satisfaction, member retention, continuity of care and drive HEDIS and QARR improvement activities.
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The HEDIS Abstractor will abstract pertinent medical record data and enter it into a specified data base to support HEDIS reporting and Quality Improvement. The HEDIS Nurse abstractor is responsible for the review of medical records and documenting critical elements proprietary data entry system.
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Demonstrates knowledge, proficiency and compliance with regulatory requirements including, but not limited to: Joint Commission, NPSG, Department of Health, HEDIS, PCMH, QI and other contractual obligations.
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Job Description About the Role: We are seeking a highly motivated and detail-oriented Clinical Pharmacist with a PharmD degree and experience in HEDIS medication adherence initiatives. Active pharmacist license in GA. Minimum of 2 years of experience in HEDIS-related medication adherence work, quality improvement, or population health.
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The organization exceeds the 90th percentile in most HEDIS measures, is among the top provider groups nationally in patient experience and provides care at a cost well below market competitors.
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At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Reliant Medical Group, part of the Optum family of businesses, is seeking an Internal Medicine Physician to join our growing care team in Auburn, Massachusetts.
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The CHW assists with the company’s HEDIS measurement goals by providing personalized support to help members achieve good health practices. Support the members’ Individual Services Plans and Crisis/Safety Plans.
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This position requires the coder to be highly proficient in the proper assignment of ICD-10 CM, PCS, CPT, HCPCS, HCC, HEDIS CAT II, E/M and modifier codes. Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care.
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Adheres to all Corporate and Departmental policies and ensures all regulatory requirements such as DOH, CMS, Medicaid, and accreditation requirements such as NCQA, URAC and HEDIS functionalities are met or exceeded.
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Timely create and exchange/transmit continuity of care document(s) with other practitioners and providers Responsible for the performance of HEDIS Part D measures (medication adherence), and SPC and CBP, CDC, MRP measures from Part CEnsures patient is managed based on risk level of EPIC Registry Predictable Risk ModelIdentify patients not meeting clinical goals, such as BP control or glucose control, and arranging for follow-up services by protocol or as appropriate.
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Supports quality programs by remaining current in internal and external quality standards and programs, such as HEDIS, AMP, NCQA and other relevant programs. Provides support and guidance to assist the QI Director to manage multiple functions that enhance cost effectiveness, ensure compliance with applicable state and federal regulatory requirements and improves health outcomes of CCH membership.
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hedis job Title: decision support
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