Job #: 2100
Title: Quality Management Operations Clerk
Purpose of Position:
The primary function of the QM Operations Clerk is to support the data collection and operational needs of Quality Management Operations. This position provides project assistance and coordination for Quality Management Operations and quality review record retrieval and storage activities related to encounter, supplemental (administrative) and the hybrid Medical Record Review projects required to report HEDIS/QARR measures to the NYS Department of Health and Centers for Medicare & Medicaid (CMS).
The role requires a technically savvy individual who can complete multiple tasks accurately and efficiently to meet hard deadlines for monthly and annual deliverables. Travel may be required throughout the 5 boroughs to support on-site record abstraction.
Monitor QM Operations medical record collection sources to include mail, fax and email and:
Respond or reroute provider questions/issues accurately and timely.
Process incoming data, including medical charts, encounter files and standard file feeds in accordance with established storage and documentation standards.
Distribute requests for records and schedule appointments with provider offices as needed to support all record collection projects and ensure internal and regulatory standards and requirements are met.
Conduct follow-up calls for medical chart requests from provider offices to ensure quality performance goals are met.
On-site provider visits to retrieve medical records.
Responsible for fulfillment of project initiatives, including completion of ad hoc operations projects as needed.
Other duties as assigned by Management.
Completion of high school/GED.
Minimum of two years relevant work experience in a managed care or health plan setting. Quality Management experience in a Managed Care setting preferred.
Knowledge of HEDIS and QARR specifications and procedures. Minimum of one-year experience as a HEDIS reviewer/abstractor with a HEDIS or RISK vendor or managed care organization preferred.
Proficient in Microsoft Office applications including Word, Excel, PowerPoint, and Access.
Proficient in Adobe Pro for file extracting, splitting and combining.
Strong written and verbal skills.
Ability to work independently, be motivated and possess excellent organizational skills and attention to detail.
Ability to prioritize to ensure reporting timeframes and deadlines are met.
Ability to travel within the service area when needed.