Sr Medical Records Auditor, RN (PRN/ Intermittent) - Denver Health Medical Plan (Must Live In Colorado)

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Department

Job Summary

Under general supervision, work with DHMP HEDIS project manager as a member of the medical record review team to complete HEDIS reviews in accordance with NCQA guidelines and technical specifications. Responsible for performing accurate and comprehensive reviews of medical records using DHMP's medical abstraction tool and software, while maintaining HIPAA Privacy and Security standards. Reviewer must pass a medical record abstraction test prior to beginning the project after completing required training. Reviewer will need to maintain competency demonstrated in test throughout the project.

Essential Functions:

• Performs provider/practitioner medical record reviews, abstraction and data entry for HEDIS and HEDIS-like measures as part of the Quality Management and Performance program of Denver Health Medical Plan (DHMP). (20%)
• Reviews assigned medical records in order to abstract clinical data elements for HEDIS reporting, meeting daily abstraction production goal and accuracy standards Examples of abstraction include: results of laboratory tests, verification of hypertension and the most recent blood pressure readings, prenatal and postpartum care services. (15%)
• Documents abstraction findings in HEDIS database tool. Maintains quality requirement of 95% accuracy with documentation guidelines throughout the review process. (15%)
• Integrates data collected from a variety of electronic and paper sources. (10%)
• Uses professional clinical judgment, maintaining HIPAA standards and confidentiality of protected health information. (10%)
• Reports critical incidents immediately. (10%)
• Participates in training, successfully completing HEDIS technical specification software training and uses software correctly to meet medical record review standards. (10%)
• Participates in daily production huddles, pursuit leads for other records, etc. (5%)
• Attends conference calls as necessary to provide information relating to clinical reviews and compliance. (5%)

Education:

• Associate's Degree in Nursing (ADN) required

Work Experience:

• 1-3 years RN patient facing experience required
• 1-3 years Managed Care HEDIS Abstraction/Auditor experience required

Licenses:

• RN-Registered Nurse - DORA - Department of Regulatory Agencies required

Knowledge, Skills and Abilities:

• Ability to work independently in a fast paced environment and assist team in meeting project deadlines.
• Must be have strong critical thinking skills, combined with keen attention to detail.
• Proficient in Microsoft Excel, Word and Outlook.

Shift

Work Type

Salary

Benefits

• Social security replacement retirement plan with employer contribution of 3%

• On-site employee fitness center and wellness classes

• Community resource navigation support

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Education & development opportunities including career pathways and coaching

Our Values

• Respect

• Belonging

• Accountability

• Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community.

Applicants will be considered until the position is filled.