RNLPN- Abstract Senior

Now hiring a RN/LPN Abstract Senior

Oversees and performs the Medical Record Retrieval Review and Reporting process to support HEDIS STARs HEDIS Like supplemental and other required regulatory reporting as well as PHP Board approved health management initiatives across the enterprise. The role assists with ensuring clinical and fiscal improvements and documents service delivery in accordance with Presbyterian Health Plan policies. The Senior Abstractor will be asked to perform duties where clinical decisionmaking may be necessary training and over read responsibilities.

How you belong matters here.

We value our employees differences and find strength in the diversity of our team and community.

At Presbyterian its not just what we do that matters. Its how we do it and it starts with our incredible team. From Information Technology to Food Services and beyond our nonclinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time Exempt: Yes
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Weekday Schedule MondayFriday
• Benefits: We offer a wide range of benefits including medical wellness program vision dental paid time off retirement and more for FT employees

• Ideal Candidate: Bachelor Degree. Registered Nurse (RN) with minimum 2 years clinical experience
  Knowledge of medical terminology knowledge of standard medical practices medical assistant medical coding or data management experience. Knowledge of Microsoft Applications including Excel and Access

• Associate degree or 3 years of additional experience in lieu of degree
• LVN/LPN with HEDIS experience and 34 years clinical experience

• Uses Performance Improvement tools and techniques to develop work plans tasks timelines and measurements for all health management project assignments. Project plans will be developed for all projects and milestones monitored and reported.
• Identifies needs designs valid and reliable tools for data collection analyzes data researches data and claims and provides feedback in an appropriate format. May assist with development and implementation of quality initiatives. Monitors outcomes and quality of services provided.
• Performs Medical Record Reviews necessary to support quality initiatives and regulatory reporting including but not limited to HEDIS reporting CMS Star measures FEHB measures Medicaid and supplemental data reporting. May be held to productivity standards as well as minimum over read standards.
• Manage an assigned caseload of provider locations and provide verbal and written progress regarding status of each providers submission of requested medical records. Excellent communication and facilitation skills are keys to success.
• Identify analyze and collect clinical information as it applies to HEDIS and NCQA requirements. *Identify probable findings indicated by clinical documentation in the medical record.
• Documents abstracted findings into a HEDIS database tool.
• Track and report on issues and outcomes related to abstractions and overreads.
• Integrate data collected from a variety of electronic and paper sources.
• Communicate significant findings including potential risk management issues to the Manager in a timely manner.
• Auditing to ensure compliance and accuracy of data abstraction and review
• Mentor abstractors in improving overall skill sets
• Manage an assigned caseload of provider locations and provide verbal and written progress reports regarding the status of each providers submission of requested medical records.
• Request medical records via most appropriate method depending on each provider (fax email mail or site visits using secure external drive or scanning etc..
• To abstract medical record documentation for Health Effectiveness Data and Information Set (HEDIS) and other initiatives as assigned.
• Organize schedule and conduct onsite medical record abstraction visits as needed.
• Communicate with assigned providers to ensure compliance to requests.
• Work with peers leadership and other departments as needed to ensure timely retrieval and abstraction of medical records.
• Convert files to usable .pdf documents for abstraction.
• Correctly name save and manage files on the Shared Drive for medical records and other project documentation as assigned.
• Following the HEDIS Technical Specifications to obtain analyze and evaluate medical record documentation submitted for HEDIS measures annual National Committee for Quality Assurance (NCQA) quality profile
• Assist in developing criteria for medical record and site reviews.
• Assist in developing educational and training materials as requested.
• Assist in identifying barriers planning interventions and implementing activities to enhance and improve provider medical record and HEDIS documentation.
• Assist in identifying and implementing interventions to better improve Service delivery to members.

All benefitseligible Presbyterian employees receive a comprehensive benefits package that includes medical dental vision shortterm and longterm disability group term life insurance and other optional voluntary benefits.

Wellness
Presbyterians Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your wellbeing. Earn gift cards and more by taking an active role in our personal wellbeing by participating in wellness activities like wellness challenges webinar preventive screening and more.

Why work at Presbyterian
As an organization we are committed to improving the health of our communities. From hosting growers markets to partnering with local communities Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients members and the communities we serve. We are locally owned notforprofit healthcare system of nine hospitals a statewide health plan and a growing multispecialty medical group. Founded in New Mexico in 1908 we are the states largest private employer with nearly 14000 employees including more than 1600 providers and nearly 4700 nurses.

Our health plan serves more than 580000 members statewide and offers Medicare Advantage Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drugfree and tobaccofree employer with smoke free campuses.