Clinical Abstraction Lead - HEDIS

Overview

The Clinical Abstraction Lead will function as client/team support during the MRR (Medical Record Review) HEDIS® season and during off-season projects. The Clinical Abstraction Lead position will have responsibility for supervising a seasonal team of abstractors, over readers and QA staff. This oversight includes quality, productivity and follow-up training of their measure specific team. This role is to ensure that the work of assigned team members meets productivity standards, quality standards and client deadlines. Primary responsibilities include production queue management based on daily reporting, work distribution, team performance, and production optimization.

HEDIS® is a registered trademark of NCQA.

Responsibilities

• Role can assist in coverage for the Manager, HEDIS®, as necessary. This includes PTO, company travel, etc.
• Works in conjunction with HEDIS® Management to oversee completion of reviews and assists with training by measure specific team assignment.
• Responsible for the day-to-day production and quality functions of a team of reviewers focused on meeting client production goals and 95%+ quality accuracy. Reviews both production and quality accuracy reporting for all assigned measures.
• Must be able to exercise independent judgement and discretion in operations management and prioritization of competing project needs to ensure deliverables are met.
• Evaluates quality feedback from team members and coordinates team for quality needs.
• Works with HEDIS® Trainer to perform QA review that is either ad hoc or scheduled.
• Addresses staff questions and work-related concerns surrounding specific measure(s).
• Addresses staff on-boarding/offboarding needs and work-related concerns surrounding follow-up training.
• Monitors team on-boarding/offboarding completion and project attendance.
• Mentors staff to maximize performance and work potential.
• Collaborates with other Team Leads.
• Will always demonstrate Cotiviti core values.
• Will adhere to compliance of the remote policy, HIPAA regulations, professional conduct and ethical practice.
• Assist in maintaining and monitoring team members’ job satisfaction and morale.Completes any special projects, such as training assistance and other duties as assigned in a timely manner.
• Will escalate matters to HEDIS® Manager or HEDIS® Trainer as appropriate.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.

Qualifications

• Registered Nurse with active, unrestricted license.
• Minimum of 5 years of clinical experience, with 7+ years of clinical experience preferred.
• Minimum of 3 years of HEDIS® team supervisory experience, with 5+ years of experience preferred.
• Minimum of 5 years of experience with NCQA HEDIS® hybrid measure abstraction including overreads/QA, with 7+ years of experience preferred.
• A Licensed Practical Nurse (LPN) with 7+ years of HEDIS® and clinical experience along with 3+ years of HEDIS® supervisory experience may be considered in lieu of Registered Nurse licensure.
• Experience working with HEDIS® data entry software and reporting tools.
• Experience working remotely on team projects.
• Must be comfortable communicating via various modes (email, IM, phone) in a timely manner.
• Must be comfortable using/learning Microsoft Office products (Outlook. Teams, Word, Excel, etc.).
• Analytical and problem-solving skills, and the ability to use data to identify patterns and trends.

Mental Requirements:

• Must possess strong communication skills to convey information across multiple team members.
• Ability to think logically and process information sequentially with a high level of detailed accuracy and efficiency.
• Strong desire to work in a quality focused production environment, and lead based on production needs and deadlines.
• Able to work in a fast-paced environment and must be adaptable with problem-solving skills.

Physical Requirements and Working Conditions:

• Must be able to sit and use a computer keyboard for extended periods of time.
• Repeating motions that may include the wrists, hands and/or fingers.
• Must be able to provide high-speed internet access / connectivity and office setup and maintenance.
• Must be able to provide a dedicated, secure work area.

Base compensation ranges from $80,000 to $95,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 10/21/2024

Applications are assessed on a rolling basis. We anticipate that the application window will close on 12/20/2024, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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