Over Reader

W3R Consulting; New Mexico; On-site; USD 42,000 - 64,000; Full time

Job summary

W3R Consulting seeks a detail-oriented HEDIS reviewer to support the HEDIS Effectiveness Data and Information Set project under supervision. You will review medical records, ensure accuracy and adherence to NCQA guidelines, and maintain strict confidentiality.

The role requires knowledge of medical terminology, data entry skills, and effective communication. Proficiency in Word/Excel and Lotus Notes is expected; auditing experience is a plus.

Qualifications

• Clinical experience and ability to follow NCQA/HEDIS guidelines.
• Accurate data entry and chart review skills.
• Experience with HIPAA/patient confidentiality.

Responsibilities

• Over-read medical record abstractions daily per HEDIS specs and BCBSIL training.
• Complete IRR/over-read tool with comments; re-review similar errors as needed.
• Identify and report abstraction errors; provide measure re-education.
• Use software to support HEDIS operations and update chase statuses.
• Meet with HEDIS Coordinator/QI to discuss efforts and open issues.
• Maintain productivity as directed by supervisors.
• Ensure HIPAA compliance and confidentiality.
• Perform other duties as assigned.

Skills

Medical terminology knowledge

Data entry

Clear written/verbal communication

PC proficiency: Word, Excel, Lotus Not

Auditing experience (preferred)

Tools

Word

Excel

Lotus Notes

Job description

DESCRIPTION

Clinical experience and will work under the supervision of the HEDIS Coordinator. They are a member of the medical record review team. The team is responsible for obtaining and performing accurate comprehensive reviews of medical records in support of The HEDIS Effectiveness Data and Information Set project. HEDIS reviews are completed in accordance with NCQA guidelines and technical specifications.

JOB REQUIREMENTS

• Knowledge of medical terminology
• Data entry and/or typing experience.
• Clear and concise written and verbal communication skills.
• PC proficiency to include Word, Excel and Lotus Notes.
• Auditing experience preferred.

DUTIES AND RESPONSIBILITIES

• Accurately and efficiently over-read medical record abstractions performed by the HEDIS abstraction staff on a daily basis according to HEDIS specifications and BCBSIL training guidelines.
• Complete the IRR/over-read tool in the Software Application, including comments if errors are found. Correct errors identified through over-read process, including a re-review of charts that may contain similar errors.
• Identify and report abstraction errors and provide measure re-education with for the abstractor.
• Utilizes various software applications to support HEDIS operations by entering data and / or changing chase status for the identified chase(s).
• Meets with HEDIS Coordinator and / or QI Specialists to discuss HEDIS efforts, any open issues and can include IRR results.
• Maintains productivity level as determined by the HEDIS Coordinator/QI Department.
• Maintain compliance with all HIPPA and patient confidentiality requirements.
• All other duties as assigned.