Description

Providence is calling a Coding Quality Auditor - HEDIS who will:

• Be responsible for conducting clinical quality audits/overreads for the Quality Department
• Identify and reports issues related to clinical audits to determine potential areas for quality improvement within the HEDIS project
• Collect data by way of chart extraction, using objective specifications for the Healthcare Effectiveness and Data Information Set (HEDIS) program
• Conduct Audits inclusive of reviewing outpatient medical records, hospital records, clinical lab and pharmacy records
• Be responsible for collecting data based on standardized methodologies and organizethe data to identify and address opportunities for improvement
• Perform chart audits electronically during the audit season
• Follow Direction provided by the HEDIS Manager in relation to charts that require auditing
• Maintain all collected records in a confidential manner and performs all duties in a manner which promotes team concept and reflects the Sisters of Providence mission and philosophy
• Will communicate in a collaborative manner with clinic and other staff with whom they interact, in a manner that represents Sisters of Providence
• Successfully complete HEDIS training prior to performing chart abstractions

This position is considered to be a temporary, per diem, seasonal role that will work forty hours per week between the months of January 2023 - May 2023.

This role is considered to be a remote position and can be worked from the majority of States within the United States. Please note Providence cannot hire within the following States / Regions:

• Alabama
• Colorado
• Delaware
• Hawaii
• Indiana
• Kentucky
• Maryland
• Michigan
• Missouri
• New Jersey
• New York – (Specifically: Yonkers & New York City)
• Ohio
• Pennsylvania
• Rhode Island

Primary Responsibilities:

• Responsible for the completion of chart abstraction audits. Quality audits include but are not limited to: patient health information, clinical testing and follow-up, quality of provider services and medical management, medical record requirements, and other quality requirements as defined by PHP, performance measurement specifications, or Federal and State regulations
• Be able to investigate perceived gaps in care identified through claims in order to identify documentation necessary to support exclusions or numerator hits
• Use claims information to track where member has received care
• Successfully complete HEDIS auditor training and competency testing
• Conduct clinical reviews using medical record/medical information, and conduct data entry and issue logging into the HEDIS Access database
• Complete inter-rater testing with passing scores
• Work with quality team to assure documentation is audit-ready
• Track and report issues related to chart abstractions and overreads
• Maintain the confidentiality of all provider and member health data and information
• Maintain data integrity with highest degree of accuracy and documentation requirements per PHP's auditor

Additional Responsibilities:

• Participate in required meetings such as HEDIS huddles

Required qualifications for this position include:

• H.S. Diploma or GED equivalency
• 3 yearsMedical record audit experience, experience with extraction of clinical data points from medical records, experience with electronic medical records (EMR), comfortable with use of technology

Preferred qualifications for this position include:

• Associate's Degree in Nursing or Healthcare related field, Health Information Management degree
• 3 yearsHEDIS, Quality management/quality improvement/utilization review auditing experience, including experience in auditing within electronic health records
• Experience with health plans,case reviews, project management and data analysis

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.

About the Team

Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.

We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.

We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.

Requsition ID: 135769

Company: Providence Jobs

Job Category: Coding

Job Function: Revenue Cycle

Job Schedule: Part time

Job Shift:

Career Track:

Department: 5018 HCS QUALITY MANAGEMENT OR REGION

Address: OR Beaverton 3601 SW Murray Blvd

Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.