HEDIS Medical Record Specialist

Overview

The Performance Measurement and Improvement (PMI) department within Blue Cross Blue Shield of Massachusetts provides expertise and leadership in performance measurement, data analytics, and information necessary to promote optimal levels of member health and member experience. We are responsible for the reporting of our annual quality management and reporting programs to meet our accreditation and regulatory requirements.

Job Responsibilities:

The HEDIS Medical Record Specialist will assist the Program Manager in preparing for the annual HEDIS submission. During the HEDIS reporting season, the HEDIS Medical Record Specialist will abstract medical records, schedule and conduct site visits to procure medical records from physician offices, work with physician offices to resolve issues related to HEDIS medical record collection, and provide support and encouragement to all temporary reviewers. He/she will assist the Program Manager in the training of all temporary HEDIS review staff and will provide direct supervision of temporary staff as needed by the Program Manager. He/she will also be a key participant in quality control checks of all work produced by temporary staff. The HEDIS Medical Record Specialist will also play a key role in identifying key operational processes that could be improved upon for the next HEDIS data collection season. The HEDIS Medical Record Specialist will work cross functionally with other departments to identify improvement opportunities on priority measures, including but not limited to engaging with provider-facing business areas to close clinical gaps in care and support Medicare 5-Star initiatives related to clinical care and preventive services.

Responsibilities:

• Provide subject matter expertise on HEDIS hybrid measure specifications to internal and external stakeholders;
• Conduct medical record abstraction either remotely via electronic medical record access or on-site in physician offices as needed;
• Develop strong, collaborative relationships with physician offices as well as internal business departments to efficiently manage medical record procurement processes and resolve issues related to these complex processes;
• Coordinate the scheduling of on-site visits with physician offices and offices that have agreed to remote chart abstraction;
• Provide training and education to physician and provider offices regarding HEDIS and clinical data abstraction requirements;
• Assist with supervision and training of temporary medical record review staff (5-7);
• Identify opportunities for improvement and be willing to communicate feedback for improving applications developed to assist medical record reviewers with the collection and abstraction of HEDIS medical records
• Work on HEDIS quality improvement activities including clinical gaps in care, provider newsletter notifications, etc.

Qualifications:

• 5+ years clinical experience in hospital, physician practice office or health plan setting
• Experience abstracting and interpreting medical records with familiarity in HEDIS measure specifications a plus
• Excellent communication and negotiation skills
• Proficiency with Microsoft Office (Outlook, Word, Excel, Access) and PDF software
• Ability to identify issues and contribute to team problem solving
• Demonstrated ability to handle multiple tasks and consistently produce high quality work products in a timely and appropriate manner both independently and as a valued member of a team
• Ability to navigate complex provider organizations and other various health care delivery systems

Education:

• Registered Nurse or Licensed Practical Nurse certification or equivalent clinical experience in a hospital, physician office, pharmacy or health plan setting

High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.