events | Spec HCQI Regulatory in New York, NY

Spec HCQI Regulatory

  • BlueShield of Northeastern New York
  • $67,400.00 - 104,060.00 / Year *
  • 411 Grand St
  • New York, NY 10002
  • Full-Time
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Coordinates and supports the HCQI team members with the development of data entry tools, tracking mechanisms for clinical and non-clinical interventions and/or processes that will allow for improved data abstraction and reporting. Assists the HEDIS Clinical team with the Medical Record Review Project and HEDIS-related interventions in addition to supporting the NCQA Coordinator with the preparation of regulatory documents for NCQA Survey Submission. Primary Responsibility Participates in departmental and corporate teams as assigned, for regulatory/accreditation projects such as HEDIS, NCQA, NYSDOH, CMS, NYSDOI, etc. Participates in job-specific HCQI meetings (HEDIS, NCQA, HCQI Team) Responsible for coordinating the annual review of HCQI Corporate Policies and Internal SOP's. Works with the clinical team to update the policies and SOP's in response to changes in process, regulations or standards. Coordinates review with the Corporate Communications team for approval. Responsible to post the Administrative policies to the Provider portal. Assists in the development and implementation of data entry tools and tracking mechanisms for clinical and non-clinical interventions. Collaborates with Health Care Analytics and IT on new and/or streamlined process flows for data entry, data abstraction and reporting capabilities for various interventions and regulatory/accreditation projects within HCQI. Takes the lead role for the HCQI team in coordinating the meetings, agendas and any follow-up related to the development and implementation of data entry tools and tracking mechanisms for clinical and non-clinical interventions. Coordinates the scheduling of meetings with the appropriate internal departments to meet the needs of the project. Responsible for training the HCQI Team on data entry tools, tracking tools and any newly developed and implemented Corporate used program (clinical platforms, reporting databases, etc). Participates in the HEDIS Medical Record Review Project. Responsibilities include: Preparation of the HEDIS MRR Provider letters and medical record requests. Coordinates review of the updated letters with the CMO. Once approved, coordinates with the Corporate Communications team for review, formatting and approval; Works with the clinical team on the Provider Chase file. Coordinates with the Heath Care Analytics team to convert the file into the mail merge file for Provider mailing. Scheduling of the training rooms for both the Clinical and Non-Clinical training sessions; Revision and formatting of the MRR training materials; Updates annual training materials for the Provider Liaisons and provides a one week training to the Liaisons; Oversees the Provider Liaisons and the Provider scheduling process to include scheduling Provider onsite visits, coordinating the retrieval of the medical records (via fax, mail, flash drive etc). Receives the daily mail correspondence, sorts, tracks, assigns and routes the information to the clinical team. Responsible for the monitoring and tracking of the faxed medical record documents in Content Manager and assignment to the clinical team. Participates in the daily HEDIS MRR touchbase meetings. Responsible for preparing the daily McKesson Compliance Reporter Provider Assignment report along with providing the status Provider assignments, medical records received and any necessary Provider follow up. Coordinates the Post-HEDIS MRR Project Barrier Analysis Participates in the NCQA Survey Submission. Performs other related duties or special projects as required. Knowledge and Skills Knowledge and understanding of proper use of CPT, HCPC, and ICD9/10 codes and medical dental terminology and coding techniques. Experience and knowledge of the following software programs is essential: Facets, Content Manager. Preferred experience and knowledge of Risk Manager and Care Radius. Experience and knowledge using Microsoft Office; High volume of work is utilizing Excel and an intermediate to high level/degree of volume in Word. Qualifications Problem Solving Skills: Understanding of the QI Processes, in order to assist QI staff in routing and preparing needed materials. Working effectively with other departments to identify and track issues and be able to problem solve these issues for solutions. Experience Associates degree in business or health related field. A minimum of 2 years' experience in a health care or regulatory related field. Previous experience with HEDIS medical records collection process preferred. Education Required Education:Associates Degree (N/A) Working Conditions Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc) Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks Vision Req: Close vision (clear vision at 20 inches or less) Heat, light, air, space and working environment typically found in an office environment Carrying Lifting - 0% to 5% - Rarely Reaching Bending Sitting - 67% to 100% Continuous Standing - 34% to 66% - Frequent Walking - 6% to 33% - Occasional
Associated topics: account, accounts receivable, clerk, coding, data, desk, insurance, medical biller, medical billing, medical transcriptionist


* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.