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Quality Improvement Medical Records Specialist

Quality Improvement Medical Records Specialist

Western University of Health SciencesSan Francisco, CA, United States
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Posting Details

About WesternU

As you take your first step onto a Western University of Health Sciences campus, each path, each person, each structure comes with a transformative story. WesternU is more than the practice of medicine. We are defined by character and culture.

At WesternU, you will discover humanism at the heart of every interaction : a warm welcome, a sincere smile, a positive word, a kind deed, a thoughtful gesture. You will see students work together on case studies; a parade of pets in campus parks; student clubs offering opportunities for career growth and community involvement; and faculty, staff and students designing their future and the future of WesternU. We display a collaborative mindset in how we operate, educate, and serve others.

Although, geographically, we are two campuses - as humanists, we are one : to enhance and extend the quality of life in our communities and achieve excellence in everything we do. We attract diverse, professional faculty, staff and students that thrive in an environment of humanistic health care education. Join our team of faculty and staff and make a difference.

Posting Details

Position Title

Quality Improvement Medical Records Specialist

Position Control Number

100555

Type of Position

Staff

Position Status

Full-time

Campus

Western University Campus-Pomona, CA

Position Location

California

Department

1313-Patient Care Center - PCC

Job Summary

To provide support services for medical records for WesternU Health. Appropriately and accurately verify and process requests for charts to be pulled for patient care, quality review, and audits in a timely manner. Release information to patients, healthcare facilities and

other entities with following all laws and regulations including HIPAA. In addition, supports the Quality Improvement team with HEDIS, Stars, P4P and Risk Adjustment activity functions related to outreach, collection and accurate data entering of medical records and service data, according to NCQA HEDIS / STARS and CMS Medicare Advantage guidelines.

The Quality Improvement Medical Record Specialist coordinates internal / external data reports aimed in closing quality care gaps and supports internal staff with daily Quality Improvement tasks such as Gap / Care due list, filing, faxing, copying, and scanning of files, acts as a liaison for the department in routine administrative and project coordination activities, including conduct effective research to meet project goals and assigned task and attends to Health Plans, IPA / MSO, provider, and inter-departmental meetings.

Knowledge, Skills and Abilities

Individuals must possess the knowledge, as well as the following skills and abilities or be able to perform the essential functions of the job, with or without reasonable accommodation using some other combination of skills and abilities.

  • Strong customer focus, interpersonal, collaboration, written / verbal communication, prioritization and computer skills.
  • Must be able to establish daily work priorities and work efficiently to contribute to the successful overall maintenance of the credentialing process.
  • Able to handle multiple simultaneous tasks and complete work projects in designed time frames.
  • Demonstrated attention to detail and good organizational capability.
  • Strong working knowledge of medical terminology including insurance credentialing.
  • Experience working with Windows based applications : Excel, Word, and Outlook.
  • Significant knowledge of State and Federal Regulatory requirements and accreditation standards, e.g., HIPAA, NCQA, NPDB, Title XXII, CAQH and NPPES.
  • Considerable working knowledge of practice management applications.
  • Ability to type, use a ten-key by touch, telephone, fax copier, scanning.

Required Qualifications

  • Education : Any combination, training or experience that provides the required knowledge, skills and abilities.
  • Experience : Two years of relevant experience in an outpatient clinic setting, with a focus on processing medical records requests and the ability to extract pertinent data from medical records.
  • Preferred Qualifications

    Preference will be given to candidates holding certification in the appropriate professional field and organizations.

  • Education : Associate degree is preferred.
  • Experience : Background in a clinical academic setting is highly preferred.
  • Essential Job Duties

    Key Responsibilities

  • Processes records requests for WesternU Health from / to : patients, physician / specialist offices, developmental service programs, hospitals / clinics, disability / social security offices / workers comp, insurance companies, attorneys / courts / subpoenas, educational facilities, auditors. Contracted Health Plan / IPA and external chart request vendors.
  • Key Responsibilities

  • Appropriately and accurately verify and process requests for charts to be pulled for patient care, quality review, and audits in a timely manner. Release information to patients, healthcare facilities and other entities with following all laws and regulations including HIPAA
  • Key Responsibilities

  • Perform and monitor tasks to ensure HEDIS data reports are worked daily within payor portals for the healthcare organizations to meet high-quality care. Record and document all patient and provider outreach activity using internal / external dashboards. Provide administrative assistance and coordination for initiated projects that includes medical record abstraction related to the Star-rating, HEDIS, and Medicare HCC efforts.
  • Key Responsibilities

  • Other duties as assigned.
  • Posting Details Continued

    Work Schedule

  • Monday-Friday, Regular Business Hours
  • Working at WesternU

    We believe in making an impact in the lives of our employees, personally, and professionally. Every employee has different individual and / or family needs. We offer benefits that are both comprehensive and flexible to address your unique needs. We believe work-life harmony is positive and achievable.

    We offer competitive salaries, generous paid time off, insurance plans, reimbursements, and retirement benefits. Additionally,

  • Our faculty, staff, and administrators are 100% focused on student success.
  • Our University culture creates the context for a nurturing and supportive environment.
  • Faculty, staff, and students can expect to make deep, personal relationships within the University community.
  • As a Faculty, Staff, or Student at WesternU, you can focus on work that you love, be your authentic self, and lead to the future with innovation in health sciences.
  • WesternU's core value of humanism encourages all to bring their whole self in all that they do.
  • We are committed to fostering a culture of respect, equity, collaboration, and fun at all levels for all people!
  • Expected Pay Scale

    Minimum

    $23.00 Hourly

    Maximum

    $26.50 Hourly

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