Lead Overreader, HEDIS Abstraction / Quality Improvement (Remote)
About the position Molina's Quality Improvement Lead Overreader conducts oversight and audits of the data collected and abstracted from medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The Lead Overreader meets chart overread productivity standards, minimum over read standards, and 2nd overread standards to ensure accuracy of their audit skills, as well as oversee the overread team to ensure they are on track to meet standards as well. Lead Overreader mentors and trains new team members. Leads special HEDIS/Quality projects. We are seeking strong experience in HEDIS abstraction and overreading. Please include your experience in these qualifiers on your resume.
Responsibilities
- Performs the lead role of the HEDIS medical record review overreader/auditor which includes ongoing review of records reviewed and data entered by the abstraction team during the annual HEDIS medical record review.
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- Acts as the subject matter expert for the team.
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- Provides feedback to providers on visit notes or feedback from the HEDIS audit.
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- Makes recommendations based off of the audit and chart review.
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- Assists Manager and Supervisor(s) in leading the training and mentoring of new staff.
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- Takes the lead role in training activities, utilizing standardized training materials and job aids.
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- Leads the team during HEDIS audits as well as ad hoc projects.
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- Leads scheduled meetings with the Abstraction team, National Training Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results.
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- Works with the Manager to monitor accuracy of abstracted records as required by specifications.
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- Assists the quality improvement staff with physician and member interventions and incentive efforts as needed through review of medical records documentation.
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- Assists in support of accreditation activities such as NCQA reviews, CAHPS and state audits by reviewing clinical documentation.
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- Provides data collection, presentations and report development support for quality improvement studies and performance improvement projects.
Requirements
- Bachelor's degree or equivalent experience.
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- 5 years experience in healthcare Quality/HEDIS specific to overreading.
Nice-to-haves
- At least 3 years of experience in the overread role.
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- 3+ years managed care experience.
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- Advanced knowledge of HEDIS and NCQA.
Benefits
- Competitive benefits and compensation package.
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