HEDIS Abstractor III

　　Job Category: Clinical

　　Department: Quality Performance Management

　　Location:

　　Los Angeles, CA, US, 90017

　　Position Type: Full Time

　　Requisition ID: 10656

　　Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)

　　Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

　　Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

　　Job Summary

　　The HEDIS Abstractor III manages medical record audit activities with the Healthcare Effectiveness Data and Information Set (HEDIS) auditors. This position is responsible for interpreting the National Committee for Quality Assurance (NCQA) measure specifications and inquiring with the Auditors or NCQA for clarification. Included are answering auditor questions, communicating with auditors on HEDIS measure specification questions, communicating audit issues and standards to abstraction staff, validating and overseeing audit sample. Interfaces with HEDIS medical record review vendors to monitor abstraction processes and accuracy.

　　This position works with the HEDIS Manager on hiring and training of abstractors. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.

　　This position coordinates provider outreach and HEDIS education activities including performing outreach, develops and/or updates educational and follow up materials, participates in determining the messaging to the providers and coaches abstractors on how and what to present to providers. This position is a resource for questions related to HEDIS received from Providers/Plan Partners/ Participating Physician Group (PPGs). Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.

　　Duties

　　Manages and coordinates medical record audit activities with the HEDIS auditors: Responsible for interpreting the NCQA measure specifications and inquiring with the Auditors or NCQA for clarification. Included are answering auditor questions, communicating with auditors on HEDIS measure specification questions, communicating audit issues and standards to abstraction staff, validating and overseeing Audit sample.

　　Manages and coordinates medical record abstraction activities: Responsible for tracking accuracy and productivity, providing training on measure specifications, and being a general resource to abstractors for technical questions.

　　Conducts HEDIS Education at provider locations: Meets with Provider/Office staff to educate on HEDIS guidelines, P4P program, CAHPS and Data Submission. Provide follow up reports, document issues, and become a resource to the provider.

　　Medical record abstraction process oversight: Develop methods for tracking the percentage of charts completed and tracking errors for maximum improvement of the accuracy of HEDIS scores. Work with the Plan Partners weekly to provide a progress report on the quality of review or completion status. Work with the external HEDIS auditor and L.A. Care medical record vendors on medical records review and HEDIS Roadmap submission.

　　Quality improvement intervention: Actively provide HEDIS specification updates/description and recommendation to intervention workgroups that will impact quality and member access to care. Complete tasks on a timely basis.

　　Improve administrative data: Collect off season medical records and data in preparation for the next HEDIS season with the goal of improving the administrative data capture for HEDIS measures. Support the processes needed to attain data from provider offices on an as needed basis. Analyze weaknesses and conceptualize and develop process to improve outcomes.

　　Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.

　　Perform other duties as assigned.

　　Duties Continued

　　Education Required

　　Associate's Degree in Public Health or Related Field

　　In lieu of degree, equivalent education and/or experience may be considered.

　　Education Preferred

　　Experience

　　Required:

　　With Associate's: At least 7 years experience with HEDIS abstraction.

　　Bachelor's Degree: At least 5 years experience with HEDIS abstraction.

　　Preferred:

　　Outpatient Health Care Experience in a Clinical or Provider setting.

　　Skills

　　Required:

　　Familiarity with and ability to apply primary care practices to understand data in medical records and build strong working relationship with providers.

　　Ability to perform as a team leader.

　　Strong communications skills: written, verbal, and interpersonal.

　　Ability to work in a team setting and provide instruction to Project Managers/Specialist, Abstractors, Analysts and Schedulers.

　　Ability to meet deadlines and work under pressure (monitor workload to complete assignments on a timely basis).

　　Ability to use HEDIS vendor tools.

　　Ability to accurately read and understand medical record documentation with clinical terminology and abbreviations.

　　Understanding of HIPAA; Abide by strict confidentiality regulations as defined by HIPAA and company policy.

　　Knowledge of various technical applications (Microsoft Office).

　　Working knowledge of the health record, computer system, and data integrity/processing techniques.

　　Licenses/Certifications Required

　　Licenses/Certifications Preferred

　　Clinical License to practice or an Administrative License to review Utilization Management cases. - Active, current and unrestricted California License

　　Medical Coding Certification

　　Accredited Health Information Technician (AHIA)

　　Required Training

　　Physical Requirements

　　Light

　　Additional Information

　　Financial Impact: Additional position required due to the impact that the Medicare Star program and Medi-Cal auto-assignment program has on the organization

　　Required:

　　Travel to offsite locations for work.

　　Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

　　L.A. Care offers a wide range of benefits including

　　Paid Time Off (PTO)

　　Tuition Reimbursement

　　Retirement Plans

　　Medical, Dental and Vision

　　Wellness Program

　　Volunteer Time Off (VTO)