Meridian

  • Quality Data Abstraction Team Lead

    Job Location US-MI-Detroit
    Job ID
    2018-5670
    Category
    Quality Improvement
    Business Line
    MHP Michigan
  • Overview

    Who we are: 

     

    Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry. 

     

    We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio.  As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide. 

     

    Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities. 

     

    A Day in the Life of a Quality Abstraction Team Lead: 

     

    This position is responsible for developing strategies and implementing processes to improve HEDIS medical record documentation, medical record review performance and medical record data integrity; specifically, this includes development and implementation of an effective corporate medical record review (MRR) strategy and having accountability for all HEDIS/MRR related requirements. This includes oversight of internal medical record databases and quality assurance processes; oversight of the annual HEDIS medical record review project, including abstractor training, inter-rater reliability testing and corrective actions. HEDIS improvement responsibilities include collaboration and training with quality staff on prioritized HEDIS measures, accreditation measures and state performance measures to analyze performance, identify barriers, and implement improvement action plans and the subsequent monitoring of same.

     

    Responsibilities

    • Works collaboratively with quality improvement staff toward implementing organization-wide Healthcare Effectiveness Data and Information Set (HEDIS) improvements; utilizes trend analysis, performance thresholds, and national and regional benchmarks to identify and act on improvement opportunities.
    • Collaborates with Disease Management, Utilization Management, Case Management and Women and Children’s Services to provide subject matter expertise to assist programs in developing new outreach activities designed to improve HEDIS performance based on field experience.
    • Works collaboratively to implement strategies and processes for educating practitioners on effective HEDIS medical record documentation and claims coding for improvements in HEDIS administrative and hybrid rates.
    • Mentors and trains new plan Abstractors on MRR.
    • Develops, communicates and assists the plan with implementing MRR best practices, including chase logic, oversampling, numerator negatives, medical record abstraction, appointment scheduling, fax strategies, and exclusions; evaluates and updates information on a regular basis as new best practices are developed.
    • Monitors weekly HEDIS MRR progress via reports and evaluates for potential or actual risks; effectively communicates identified risks to Quality Improvement Leadership and leads investigation and resolution of identified risks.
    • Provides oversight of medical record progress for convenience and validation sampling and provides final over-read of selected medical records.
    • Manages oversight of internal medical record databases; ensures appropriate training of all individuals entering clinical data into medical record databases; and monitors quality assurance processes.
    • Participates as a subject matter expert (SME) in HEDIS planning activities including the HEDIS Committee.
    • Perform other duties as assigned

    Qualifications

    What you can bring to Meridian:

    • Bachelor’s degree or Fellow Designation from the Academy of Healthcare Management (AHM) is required
    • Current State license as a Registered Nurse is preferred
    • Ability to obtain current Registered Nurse Licensure in multiple states
    • At least five years of relevant clinical experience involving medical record documentation or medical claims experience
    • Previous experience in managed health care and Medicaid programs is preferred
    • 2+ year(s) of top performance as a non-management Family Member during which leadership abilities were demonstrated is preferred
    • Detailed knowledge of computers/systems including word processing and Excel spreadsheets.
    • Strong knowledge base of HEDIS Technical Standards
    • Knowledge of claims and coding sets
    • Knowledge of MS Project software
    • Strong knowledge base of HEDIS Technical Standards and HEDIS Compliance Audit Standards
    • Excellent written, verbal, presentation, and inter-personal skills
    • Strong computer skills, including Microsoft Office (Word, Excel, PowerPoint)
    • Strong analytical and data interpretation skills
    • Strong organizational skills
    • Ability to exercise good judgment and maintain confidentiality
    • Ability to work cooperatively with peers and subordinates
    • Ability to oversee and comprehend department activities at a detailed level
    • Ability to motivate others toward achievement of common goals
    • Ability to think creatively to resolve common barriers and issues
    • Ability to travel in multiple states

    What Meridian can offer you: 

     

    • Our healthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members.  
    • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities. 
    • Meridian offers 401k matching that is above the national average.  
    • Full-time Meridian employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees. 
    • Meridian was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.  

     

    Equal Opportunity Employer 

    #MSTR

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