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Oregon Dental Service

Medical Records Review Coordinator

Oregon Dental Service - Portland, OR

Let’s do great things, together

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

Moda Health is seeking a Medical Record Review Coordinator in our Quality Programs department. The Medical Record Review (MRR) Coordinator position coordinates the medical record retrieval/abstraction/review of HEDIS and other clinical quality & risk management projects.

Primary Functions:

1. Is the liaison for the medical record retrieval and medical record abstractor vendors to help ensure the HEDIS project milestones are met; oversees vendor operational production

2. Trains the internal nurse auditor, assigns chart over-reads and ensures timely completion

3. Develops, documents and implements project task training for Healthcare Services and Medical Provider Relations staff assisting in HEDIS and monitors progress

4. Performs quality reviews of retrieved medical records to determine completeness and accuracy according to the HEDIS technical specifications

5. Performs hard copy or electronic HEDIS medical record data abstractions as needed

6. Troubleshoots providers’ office issues related to medical record reviews

7. Retrieves hard copy records from provider offices as needed

8. On an ongoing basis, implements the work plan to expand electronic medical record access for both HEDIS and Risk Adjustment to save cost, improve efficiency in data abstraction and reduce the administration burden to provider offices

9. Supports the HEDIS project manager in HEDIS production and post-production work plan activities, including IDSS data submissions to the HEDIS auditor and NCQA

10. Plays an essential role in HEDIS quality and continuous improvement within the job scope

11. Assists the Risk Adjustment team in chart retrievals for Hierarchical Condition Category projects

12. Participates in NCQA-mandated audit preparedness of HEDIS operations

13. Interprets HEDIS technical specifications to internal stakeholders as it relates to improving rates of NCQA accreditation and Medicare star ratings measures

14. Assists in designing and developing reports for internal customers

Are you ready to be a betterist?

If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

Required Skills

1. Degree in nursing or health-related field

2. If RN or LPN, current unrestricted Oregon nursing license. If medical records or health information technician, Registered Health Information Technician (RHIT) preferred

3. 1-2 years medical claim processing experience dealing with all types of plans and claims or coding patients’ medical information for insurance billing or in medical records abstraction

4. Demonstrated ability to handle difficult provider calls with little assistance

5. Strong clinical background to analyze the contents of the medical record although no direct contact with patients is required

6. Analytical, problem solving, memory retention, organizational and detail oriented

7. Maintain confidentiality and privacy according to HIPAA regulations

8. Excellent verbal and interpersonal communication skills

9. Project a professional business image telephonically and in person

10. Ability to work well under pressure, with multiple stakeholders

11. In depth knowledge of Facets Extended Enterprise systems

12. Proficiency with personal computer and Microsoft Office

13. Ability to come into work on time and on a daily basis

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Health plans in Oregon, Washington and Alaska provided by Moda Health Plan, Inc. Dental plans in Oregon provided by Oregon Dental Service. Dental plans in Alaska provided by Oregon Dental Service dba Delta Dental of Alaska.

9 days 20 hours ago

Oregon Dental Service

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Medical Records Review Coordinator Oregon Dental Service - Portland, OR, United States

   

Location: Portland, OR

Company Profile:
At Moda Health, we’re passionate about helping you on your journey to be better. We know that dealing with health concerns can be tough – and that it is a juggling act to fit in healthy choices every day. That’s what we’re here for. We’ll be your guide, your supporter, your fan club and your partner ready to help you every step of the way.