Job Description
Note: The job is a remote job and is open to candidates in USA. Agilon health is a company focused on improving healthcare quality and efficiency. They are seeking a HEDIS Abstractor and Overreader to manage the HEDIS Medical Record Review process, ensuring compliance with HEDIS measure specifications through accurate data abstraction and collaboration with stakeholders. Responsibilities • Review and abstract clinical data from electronic medical records in alignment with HEDIS technical specifications • Perform overreads of abstracted medical records for accuracy, completeness and measure compliance • Demonstrate high level of proficiency in HEDIS measures and coding standards (including but not limited to ICD-10, CPT and CPTII) to close gaps in care • Collaborate with internal and external partners to resolve documentation discrepancies and provide recommendations for improvement • Support audit preparation and participate in internal quality reviews and training sessions • Manages all activities to meet health plan contractual and reporting timeframes • Identify trends in abstraction that may impact measure performance or audit readiness and proactively escalate to leadership • Other duties as assigned Skills • Minimum of 2 years' experience working with NCQA HEDIS programs and/or HEDIS abstraction in all measures • Proficiency in EMR platforms (i.e., Epic, Cerner) and abstraction tools • Familiarity with Medicare Advantage lines of business and Stars Measures • Familiarity with supplemental data processes and quality data integration • High School Diploma or equivalent required • Ability to be a team player and exercise initiative in responding to team members or Sr. Manager • Thorough understanding of medical record documentation and medical terminology • High level of attention to detail and ability to follow direction on project deadlines • Ability to work independently • Strong language skills in English speaking and understanding • Ability to meet high productivity requirements and Interrater Reliability standards • Strong Excel skills • Ability to interpret compliance vs non-compliance on health plan gap file use to direct abstraction efforts • Ability to apply deep level of measure understanding to legal medical records • Strong Adobe skills (including saving records in PDF format and annotation) • Ability to interpret large data files for needed abstraction • Deep level of ability to recognize medical records that are not complete or are missing needed data points in overreading • Ability to report clearly on both positive or negative findings and apply possible solutions on Team calls Company Overview • Agilon Health partners with primary care physicians to define a new standard of quality, efficiency and patient experience. It was founded in 2016, and is headquartered in Long Beach, California, USA, with a workforce of 501-1000 employees. Its website is Apply tot his job
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