HEDIS Data Auditor - Population Health

Automatic Data Processing, Inc.; Miami (FL); On-site; USD 24,000 - 33,000; Full time

Job summary

Automatic Data Processing, Inc. in Miami hires a Population Health Compliance Technician to perform medical record reviews for HEDIS measures, data abstraction, and coding quality under HIPAA.

The role requires a high school diploma or GED, completion of a Medical Coding or Medical Assisting program, CPR certification, knowledge of ICD-9/CPT, and bilingual English/Spanish preferred. This is an on-site, full-time hourly role.

Qualifications

• Graduate from a Standard High School or GED Equivalent
• Graduate from an approved Medical Coding Program, Medical Assisting program preferred
• Maintain current CPR certification from the American Heart Association
• MA certification or coding certification desired
• Knowledge of ICD9 and CPT Coding
• Bilingual in English/Spanish preferred

Responsibilities

• Performing accurate and comprehensive reviews of medical records for HEDIS measures
• Auditing high volumes of medical records to ensure correct and appropriate code assignment
• Ability to multitask and troubleshoot problems independently
• Ensuring accurate data entry for claim submission
• Medical record review, data abstraction, and quality experience
• Schedule appointments with health care provider including appointments to PCP for their health risk assessments, preventative visits and chronic care management
• Participate in Performance Improvement Activities
• Participate in appropriate continuing education in service training
• Maintain current licensure and/or certificates
• Ability to read and interpret medical documents
• Ability to prioritize, multi-task, and achieve goals on time; work independently and to self-motivate
• Strong data entry skills; capable of using a computer efficiently and effectively
• Able to navigate and master practice management and EHR software programs
• Treat clients, team members and the public with courtesy, respect and present a positive public image
• High production environment and, candidates must adhere to measured productivity requirements
• Ensuring adherence to NCQA HEDIS guidelines
• Research medical history to determine the most appropriate and source of necessary documentation
• Based on a strong knowledge of HEDIS criteria, identify the medical information that supports the specific HEDIS measure
• Responsible for obtaining, organizing, and securing a large volume of medical records within a limited timeframe
• Adhere to department Policies and Procedures in performing duties and assignments
• Demonstrates the ability to work with a diverse population
• Ability to post appropriate CPT Category II Performance Measure codes after chart review and audit
• Reports to work on time and ready to work with minimal absenteeism
• Adheres to Confidentiality Policies and Procedures / HIPAA Regulations
• Well organized with the ability to maintain attention to detail
• Ability to work independently and as a team member
• Maintains productivity standard of reviewing 60 medical records daily

Skills

Medical Terminology

Keyboard

Medicare/Medicaid knowledge

NCQA HEDIS requirements

ICD9 and CPT Coding

Basic computer knowledge

Bilingual English/Spanish

Education

High School Diploma or GED

Medical Coding Program

Medical Assisting program preferred

Job description

Automatic Data Processing, Inc. in Miami hires a Population Health Compliance Technician to perform medical record reviews for HEDIS measures, data abstraction, and coding quality under HIPAA.

The role requires a high school diploma or GED, completion of a Medical Coding or Medical Assisting program, CPR certification, knowledge of ICD-9/CPT, and bilingual English/Spanish preferred. This is an on-site, full-time hourly role.