PacificSource Health Plans

  • HEDIS Medical Records Review Auditor Nurse- Temporary Position (Ends December 2018)

    Job Location US-OR-Bend
    Job ID
    2018-258
    Type
    Temporary Part-Time
    Hiring Pay Range
    $35.00 per hour
    # of Openings
    2
    Status
    Exempt
  • Overview

    Position Overview: Temporary contract position to review medical charts at Bend PacificSource office. Medical records will be reviewed to find documentation for annual HEDIS audit of care provided to Medicare members. Data elements being sought are laboratory results, blood pressures, body mass index, colon cancer screening, and other aspects of care.  Approximate duration from August 2018 - December 2018 (subject to change) with possible extension through May 2019.

     

    Preference will be given to candidates that can be available for the full duration.  

    Responsibilities

    Essential Responsibilities:

    1. The auditor will review medical records obtained by a vendor and available electronically at the PacificSource office.
    2. The medical record review on the members in the population will be performed according to NCQA HEDIS specifications.
    3. Data will be entered using certified HEDIS software on laptop computer after training has been completed.
    4. The medical record will be reviewed for confirmation of member identification, data elements, numerator events and contraindications per HEDIS specifications outlined on MRR tools in the certified software system.
    5. The medical record will be reviewed for confirmation of member identification, data elements, numerator events and contraindications per HEDIS specifications outlined on MRR tools in the certified software system.
    6. Ability to audit with 95% accuracy.
    7. Protect PHI by never leaving laptop in car.
    8. Always lock computer when leaving its location.
    9. Do not reveal passwords.
    10. Do not discuss PHI with anyone who does not have a legal need to know.
    11. All photocopied medical records will be handled according the health plan confidentiality and safe guarding PHI policy and procedure.

    Supporting Responsibilities:

    1. Use of digital camera.
    2. Meet department and company performance and attendance expectations.
    3. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
    4. Perform other duties as assigned.

    Qualifications

    Work Experience: Acute care experience or experience in a primary care clinic or experience with disease management. Experience using or viewing electronic medical records. Experience performing chart audits preferred.

     

    Education, Certificates, Licenses: Valid Oregon nursing license or other clinical licensure.

     

    Knowledge: Knowledge of standards of care for diabetes.  

     

    Competencies

    Our Values

    • Adaptability
    • Building Customer Loyalty
    • Building Strategic Work Relationships
    • Building Trust
    • Continuous Improvement
    • Contributing to Team Success
    • Planning and Organizing
    • Work Standards
    • We are committed to doing the right thing.
    • We are one team working toward a common goal.
    • We are each responsible for our customers’ experience.
    • We practice open communication at all levels of the company to foster individual, team and company growth.
    • We actively participate in efforts to improve our communities-internal and external.
    • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.

     

    Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 35% of the time.

     

    Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions.  Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

     

    Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

     

    PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

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