About this role
Job Summary
Molina's Quality Improvement Abstraction team functions to conduct data collection and abstraction of medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The abstraction team will meet chart abstraction productivity standards as well as minimum over read standards.
Job Duties
- Coordinates the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review.
- Participates in meetings with vendors for the medical record collection process.
- As needed, may collects medical records and reports from provider offices, loads data into the HEDIS application, and compares the documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed.
- Participates in scheduled meetings with the National Over read team, National Training Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results.
Job Qualifications
REQUIRED EDUCATION:
High School Diploma or equivalency
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
- 3 years experience in healthcare
- Basic knowledge and understanding of HEDIS projects
PREFERRED EDUCATION:
Bachelor’s Degree
PREFERRED EXPERIENCE:
- At least one year of medical record abstraction experience or 3-5 years experience with HEDIS audits (including but not limited to chart collection, project management, etc.)
- 1 year managed care experience.
- Advanced knowledge of HEDIS and NCQA
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
Active RN license for the State(s) of employment
STATE SPECIFIC REQUIREMENTS:
PHYSICAL DEMANDS:
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Other facts
About Molina Healthcare
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.
What you'll do
- The Abstractor will coordinate the HEDIS medical record review and participate in meetings with vendors regarding the medical record collection process. They will also collect medical records, load data into the HEDIS application, and ensure that services have been correctly performed according to specifications.
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