JOB DESCRIPTION Job Summary
Provides support for Molina enterprise quality improvement abstraction activities. Responsible for data collection and abstraction of medical records for Healthcare Effectiveness Data and Information Set (HEDIS) and HEDIS-like initiatives and compliance, and supplemental data collection activities. Meets chart abstraction productivity standards and minimum overread standards.
Essential Job Duties
• Facilitates HEDIS medical record review, including ongoing review of records submitted by providers and the annual HEDIS medical record review process.
• Participates in meetings with the national overread team, national quality training team, the regional HEDIS team, vendors and HEDIS auditors for quality/HEDIS review activities to coordinate medical records and quality-related initiatives.
• Participates in meetings with vendors to enable the medical records collection process.
• As needed, may collect medical records and reports from provider offices, load data into the HEDIS application, and compare documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed.
Required Qualifications
• At least 2 years of experience in the health care industry, preferably in a quality-related role, or equivalent combination of relevant education and experience.
• Basic knowledge and understanding of HEDIS and NCQA.
• Attention to detail and organizational skills.
• Ability to work independently in a fast-paced, deadline-driven environment.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.
Preferred Qualifications
• Medical record abstraction experience.
• Experience with HEDIS audits (including but not limited to chart collection, project management, etc.).
• Managed care experience.
• Intermediate knowledge related to HEDIS and National Committee for Quality Assurance (NCQA).
• Registered Nurse (RN). If licensed, licensed must be active and unrestricted in state of practice.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care.
Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.
