Quality Performance Analyst RN - Kansas City Metropolitan Area

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience.

Some of our offerings include :

Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute

Annual incentive bonus plan based on company achievement of goals

Time away from work including paid holidays, paid time off and volunteer time off

Professional development courses, mentorship opportunities, and tuition reimbursement program

Paid parental leave and adoption leave with adoption financial assistance

Employee discount program

Job Description Summary :

The Quality Performance Analyst RN provides clinical interpretation of medical records for HEDIS reporting. This position involves abstraction of clinical information from medical records that meet Hedis measure requirement and entering them into the Hedis abstraction tool.

The Quality Performance Analyst provides coding guidance to team members and conducts training and medical record audits along with the creation of training materials covering the HEDIS certified reporting software.

The candidate for this position must reside in the Kansas City Metropolitan Area.

Job Description

• Analyzes Medical Records for HEDIS hybrid reporting and supplemental data submission.
• Responsible for the writing, development & annual updating of abstraction training materials; creation of sample member database used for in-classroom training of vendor abstraction tool;

loading of sample medical records into vendor provided training system; providing training, mentorship, correction & other support as needed for annual novice contingent abstraction workforce.

• Responsible for the coordination, development and writing of the first HEDIS Auditor Training Manual and program.
• Subject matter expert on HEDIS abstraction reporting software and auditing of medical record abstraction.
• Responsible for resolving and responding to the audit firm concerning the abstraction reporting software, audit and interrater reliability reporting (IRR) portion of the Issue Log events.
• Responsible for assigning & monitoring abstraction work; performing of quality audit of abstractions performed by contingent workers;

providing constructive feedback, correction & mentorship to annual contingent workforce.

Responsible for over reading a 10% random sampling of in-house contingent quality auditors' audits in abstraction reporting software;

conducting quality audits of measures as entered into abstraction reporting software by medical record abstractors.

• Responsible for submitting requested medical records to the audit firm, Attest, at the end of the hybrid season for final audit : Compile all requested medical records and review each for measure requirements, Coordinate gathering of additional medical records or clarification of records as needed prior to submission to auditors.
• Acts as primary coding resource for all HEDIS & quality improvement related reporting activities.
• Responsible for maintaining inter rater reliability (IRR) scores for all abstraction staff in accordance with NCQA guidelines.
• Educates staff regarding specific HEDIS and supplemental data sources (SDS) questions in reference to measure interventions and NCQA Technical Specifications for measure performance requirements.
• Responsible for coordination, implementation, and follow-up and reporting of performance improvement plans for contingent abstractors who fall below 95% accuracy (IRR) on any HEDIS quality measure;

delivering performance improvement plans and final results to department manager and the audit firm (Attest) for all abstractors completing performance improvement plans successfully.

• Participates in projects to improve clinical processes and outcomes.
• Other duties as assigned.

Minimum Qualifications

• Bachelor's degree in Nursing, Health Care Administration, Statistics, Mathematics, or other relevant discipline or equivalent combination of education and experience.
• Registered Nursing license.
• Two years of healthcare or health insurance industry experience.
• One year of Quality Management experience required.
• One year of HEDIS experience in medical record abstraction.
• Intermediate level knowledge of and ability to use Microsoft Windows and Office applications such as Word, Excel, and PowerPoint
• Strong knowledge of medical terminology, medical coding and health care or managed care.
• Strong time management skills
• Proven organizational and time management skills
• Conscientious problem solver, willing to learn, and take personal pride in their work performance / accuracy
• Ability to teach HEDIS material to contingent workers and offer feedback regarding audits.
• Excellent verbal and written communication skills, clear, concise, and appropriate.
• Experience with Excel and Access as a report writing tool.

Preferred Qualifications

• Bachelor's degree in nursing preferred.
• Working knowledge of HIPAA requirements, NCQA, HEDIS and state / federal requirements for managed care is strongly preferred

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.