Sr Medical Records Auditor, Denver Health Medical Plan
Full Time
Denver, CO 80204
$33.61 - $50.43 an hour
Posted
Job description
We are recruiting for a Sr Medical Records Auditor, Denver Health Medical Plan to join our team!
We are here for life’s journey.
Where is your life journey taking you?
Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all:
Humanity in action, Triumph in hardship, Transformation in health.
Education:
Work Experience:
Licenses:
Knowledge, Skills and Abilities:
Denver Health values the unique ideas, talents and contributions reflective of the needs of our community. For read more about our commitment to diversity visit:
We are here for life’s journey.
Where is your life journey taking you?
Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all:
Humanity in action, Triumph in hardship, Transformation in health.
Department
Managed Care Administration
Job Summary
Under general supervision, work with DHMP HEDIS project manager as a member of the medical record review team to complete HEDIS reviews in accordance with NCQA guidelines and technical specifications. Responsible for performing accurate and comprehensive reviews of medical records using DHMP's medical abstraction tool and software, while maintaining HIPAA Privacy and Security standards. Reviewer must pass a medical record abstraction test prior to beginning the project after completing required training. Reviewer will need to maintain competency demonstrated in test throughout the project.
Essential Functions:
Under general supervision, work with DHMP HEDIS project manager as a member of the medical record review team to complete HEDIS reviews in accordance with NCQA guidelines and technical specifications. Responsible for performing accurate and comprehensive reviews of medical records using DHMP's medical abstraction tool and software, while maintaining HIPAA Privacy and Security standards. Reviewer must pass a medical record abstraction test prior to beginning the project after completing required training. Reviewer will need to maintain competency demonstrated in test throughout the project.
Essential Functions:
- Performs provider/practitioner medical record reviews, abstraction and data entry for HEDIS and HEDIS-like measures as part of the Quality Management and Performance program of Denver Health Medical Plan (DHMP).
- Reviews assigned medical records in order to abstract clinical data elements for HEDIS reporting, meeting daily abstraction production goal and accuracy standards Examples of abstraction include: results of laboratory tests, verification of hypertension and the most recent blood pressure readings, prenatal and postpartum care services.
- Documents abstraction findings in HEDIS database tool. Maintains quality requirement of 95% accuracy with documentation guidelines throughout the review process.
- Integrates data collected from a variety of electronic and paper sources.
- Uses professional clinical judgment, maintaining HIPAA standards and confidentiality of protected health information.
- Reports critical incidents immediately.
- Participates in training, successfully completing HEDIS technical specification software training and uses software correctly to meet medical record review standards.
- Participates in daily production huddles, pursuit leads for other records, etc.
- Attends conference calls as necessary to provide information relating to clinical reviews and compliance.
Education:
- Associates degree in Nursing (ADN) required.
Work Experience:
- One year of RN patient facing Required and
- Two years of medical record review experience preferred
Licenses:
- RN-Registered Nurse - DORA - Department of Regulatory Agencies Required
Knowledge, Skills and Abilities:
- Knowledge required.
- Ability to work independently in a fast paced environment and assist team in meeting project deadlines.
- Must be have strong critical thinking skills, combined with keen attention to detail.
- Proficient in Microsoft Excel, Word and Outlook.
Shift
Work Type
Regular
Salary
$33.61 - $50.43 / hr
Benefits
-
Competitive pay
-
Outstanding benefits
-
Education opportunities
-
Shared leadership and advancement opportunity
-
State-of-the-art facilities
-
Immediate retirement plan matching
-
Professional clinical advancement program
-
Participation in evidence-based projects
-
Public Service Loan Forgiveness (PSLF) eligible employer
-
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
Our Values
-
Respect
-
Belonging
-
Accountability
-
Transparency
All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.
As Colorado’s primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.
Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.
As Colorado’s primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.
Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
Denver Health values the unique ideas, talents and contributions reflective of the needs of our community. For read more about our commitment to diversity visit:
https://www.denverhealth.org/for-professionals/careers/diversity-and-inclusion
jorgevillanueva.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, jorgevillanueva.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, jorgevillanueva.com is the ideal place to find your next job.