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Presbyterian is seeking a talented Senior Quality Improvement Abstract

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 decision-making may be necessary, training and over read responsibilities.

Some key responsibilities include:

• 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 over-reads.
• Integrate data collected from a variety of electronic and paper sources.

Qualifications:

• High School Diploma Required
• LVN, LPN, Coding Certification or other healthcare related field
• Knowledge of medical terminology, knowledge of standard medical practices, medical assistant, medical coding or data management experience *Knowledge of Microsoft Applications, including Excel
• At least one year of prior HEDIS Chart Abstraction experience
• Preferred:
• Bachelor Degree
• Registered Nurse (RN) with minimum 2 years clinical experience

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being 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, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services