|HEDIS QA Overreader:
This position is a non-exempt remote or home based temporary/seasonal position and is responsible for accurately overreading and QA of medical records abstracted by the Altegra HEDIS abstraction staff for clients. The HEDIS QA will be assigned a volume of IRRs and Overreads per season and is expected to complete them in the timeframe set forth by Altegra and within the productivity and accuracy standards as defined each season. IRR and Overread result reports will be produced weekly by the IRR / Overreader. The HEDIS Overreader directly contributes to the success of the abstraction project.
- Accurately and efficiently overread medical record abstractions performed by the HEDIS abstraction staff.
- Review a sample of abstractions from each assigned abstractor on a weekly basis through the data collection tool (the “Software Application”) per HEDIS® specifications and Altegra training guidelines:
- Abstractions are performed on the correct member, and the correct measure
- The abstractor interprets the specifications for the measure correctly
- The abstractor translates the specifications for the measure to the data collection tool correctly.
- Complete the IRR/overread tool in the Software Application, including comments if errors are found.
- Immediately correct errors identified through overread process, including a re-review of charts that may contain similar errors
- Contact the abstractors at least weekly to report/discuss IRR / overread findings.
- Notify the appropriate abstraction supervisor of individual IRR / overread findings
- Communicate all common abstraction issues to the Director of HEDIS Abstraction and to Abstraction Supervisors.
- Meet routinely with Director and Abstraction Supervisors to discuss IRR results and discuss any open issues
- Raise questions or concerns in a timely manner via email or phone
- Participate in retraining as requested by Abstraction Supervisors
- Prepare routine IRR scoring reports for each client as necessary.
- Maintain compliance with all HIPAA and patient confidentiality requirements
- Complete timesheets on a weekly basis
- Healthcare professional (RN/LPN/LVN)
- Medical record professional (coder, medical record technician, registered health Information technician, registered health information administrator, etc.), or Certified Professional in Healthcare Quality (CPHQ)
- Combination of education and relevant experience deemed appropriate to fulfill the position
- 2 years of experience performing HEDIS medical record review
- 2 years of clinical experience or medical coding experience
- Ability to work independently in a fast-paced and changing environment
- Ability to interact with management personnel
- Excellent verbal, written, and interpersonal communication skills