Lead Abstractor, HEDIS/Quality Improvement (Remote)

About the position

The Lead Abstractor for HEDIS/Quality Improvement at Molina Healthcare is responsible for conducting data collection and abstraction of medical records for HEDIS projects and related initiatives. This role involves leading a team of abstractors, ensuring compliance with productivity and quality standards, and collaborating with various stakeholders to enhance the quality of healthcare data and improve overall project outcomes.

Responsibilities
• Coordinate and prepare for the HEDIS medical record review, including ongoing review of records submitted by providers.
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• Lead meetings with vendors for the medical record collection process.
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• Assist Manager and Supervisor(s) in training abstractors using standardized training materials.
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• Collect medical records and reports from provider offices as needed, loading data into the HEDIS application and verifying documentation against specifications.
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• Monitor accuracy of abstracted records in collaboration with the National Over read team.
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• Participate and lead meetings with various teams and vendors regarding quality and HEDIS review results.
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• Mentor entry and senior-level abstractors.
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• Support quality improvement staff with physician and member interventions through medical record reviews.
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• Assist in accreditation activities such as NCQA reviews and state audits by reviewing clinical documentation.
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• Provide data collection, presentations, and report development support for quality improvement studies.

Requirements
• Bachelor’s degree or equivalent experience.
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• 5 years of experience in healthcare Quality/HEDIS specific to medical record review and abstraction.
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• Intermediate knowledge of HEDIS and NCQA.

Nice-to-haves
• 3+ years of medical record abstraction experience.
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• 3+ years of managed care experience.
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• Advanced knowledge of HEDIS and NCQA.
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• Active RN license for the State(s) of employment.

Benefits
• Competitive benefits and compensation package.