Job Description
Note: The job is a remote job and is open to candidates in USA. Cohere Health is a company that delivers AI-powered solutions to streamline access to quality care. They are seeking a detail-oriented and certified HEDIS Clinical Terminologist to validate automated measure results and support quality improvement efforts through medical record data analysis. Responsibilities • Review EHR and PDFs of medical records to collect HEDIS conformant data elements. • Be able to validate that our automated solutions are pulling and coding the data appropriately with respect to diagnosis, procedures and services (ICD10, HCPCS, CPT, SNOMED, LOINC) • Adhere to NCQA technical specifications for each HEDIS measure. • Familiarity with measure sets like Adult BMI, Breast Cancer Screening, Colorectal Cancer Screening, and CDC measures. • Remain current on NCQA reporting standards and evolving measures • Abstract and code clinical data from medical records in a HEDIS and STARS conformant manner. • Understand evolving measure criteria, keep current on measure specifications and evaluate clinical documentation to determine compliance with specific HEDIS measure criteria. • Work with data and clinical teams to validate clinical and informatics intent. • Identify and flag unexpected and discordant technological outcomes supporting opportunities for product improvement. • Participate in audits, quality assurance and product improvement activities as needed. • Ensure confidentiality and compliance with HIPAA and company policies. Skills • 2+ years of recent HEDIS abstraction experience, including familiarity with STARS measures. • Strong clinical acumen with the ability to translate clinical information into codified concepts (e.g.ICD10, HCPCS, CPT, SNOMED, LOINC) - LPN, RN, or Medical Assistant. • Strong knowledge of NCQA HEDIS guidelines, CMS STARS specifications, and risk adjustment. • Experience using HEDIS abstraction tools. • Review EHR and PDFs of medical records to collect HEDIS conformant data elements. • Be able to validate that our automated solutions are pulling and coding the data appropriately with respect to diagnosis, procedures and services (ICD10, HCPCS, CPT, SNOMED, LOINC). • Adhere to NCQA technical specifications for each HEDIS measure. • Familiarity with measure sets like Adult BMI, Breast Cancer Screening, Colorectal Cancer Screening, and CDC measures. • Remain current on NCQA reporting standards and evolving measures. • Abstract and code clinical data from medical records in a HEDIS and STARS conformant manner. • Understand evolving measure criteria, keep current on measure specifications and evaluate clinical documentation to determine compliance with specific HEDIS measure criteria. • Work with data and clinical teams to validate clinical and informatics intent. • Identify and flag unexpected and discordant technological outcomes supporting opportunities for product improvement. • Participate in audits, quality assurance and product improvement activities as needed. • Ensure confidentiality and compliance with HIPAA and company policies. • Previous experience working with Medicare Advantage or managed care organizations. • Familiarity with electronic health record (EHR) systems and data abstraction from unstructured sections of their documentation. • Familiarity with HEDIS primary source verification and HEDIS audit processes. • Previous experience abstracting appropriate clinical data elements, and applying conformant ICD-10, CPT, and HCPCS codes supporting NCQA and CMS STARS conformant measurement capture. • Previous experience or familiarity with risk adjustment. Company Overview • Cohere Health is a SaaS company that focuses on improving the efficiency and effectiveness of healthcare delivery. It was founded in 2019, and is headquartered in Boston, Massachusetts, USA, with a workforce of 501-1000 employees. Its website is Apply tot his job