Quality Audit Specialist - Hybrid

Title: Quality Audit Specialist - Hybrid

Mandatory skills:

HEDIS, Quality Rating System, QRS,
HealthCare Effective Data and Information Set, HEDIS, Medical Record, HIX, Health Insurance Exchange,
Electronic Medical Records, EMR, Electronic Health Record, EHR,
electronic clinical records, medical record documentation, medical records data collection,
MS Office Suite, MS Word, MS Excel, MS PowerPoint, MS SharePoint,
clinical data, clinical validation, auditing, chart audits, data analysis, data entry,
supplemental process, technical specifications, regulatory, accrediting compliance, standard operating procedure, SOP

Description:

This position is responsible for ensuring the audit and review of electronic clinical records to ensure they accurately reflect medical record documentation to meet regulatory and accrediting compliance mandates.
This position will be responsible for oversight and review of the abstraction/extraction process of clinical data from Electronic Medical Records (EMRs); auditing supplemental files supplied by providers and vendors for HEDIS, Quality Rating System (QRS) and other quality measures; identifying areas of opportunity to improve documentation and audit outcomes. This position impacts the integrity of the Medical Record validation process and HealthCare Effective Data & Information Set (HEDIS) Reporting. In addition, this position significantly contributes toward the achievement to maintenance of accreditation with national accreditation client.

Individual must demonstrate strong multi-tasking setting priorities based upon minimal direction including:
Understanding of NCQA HEDIS quality measures and code value sets.
Conducts clinical validation on incoming supplemental data files.
Maintains standard operating procedures (SOPs), user guides to reflect accurate and updated processes
Educates internal and external stakeholders (e.g., providers, vendors) in supplemental processes
Supports clinical validation during the onboarding process including primary source verification (PSV) during official/mock audits.
Conducts analysis and investigation on inquiries related to medical records data collection tied to technical specifications
Collaborates with technical staff in performing research and assist in data analysis
Maintains productivity level with less than a 5% error rate in record abstraction and data entry on an ongoing basis.
Strong proficiency with tools, language MS Office Suite: MS Word, MS Excel, MS PowerPoint, and MS SharePoint.
Familiar with HIX (Health Insurance Exchange), EMR (Electronic Medical Record), EHR (Electronic Health Record) types of data collection.
Apply structured auditing criteria to abstract medical records, follow defined procedures for saving approved medical record documentation and accurately enter the results of chart audits
Maintain complete confidentiality of company related business.
Maintain effective communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

Notes:
Contract to Hire
Onsite/Hybrid

VIVA USA is an equal opportunity employer and is committed to maintaining a professional working environment that is free from discrimination and unlawful harassment. The Management, contractors, and staff of VIVA USA shall respect others without regard to race, sex, religion, age, color, creed, national or ethnic origin, physical, mental or sensory disability, marital status, sexual orientation, or status as a Vietnam-era, recently separated veteran, Active war time or campaign badge veteran, Armed forces service medal veteran, or disabled veteran. Please contact us at for any complaints, comments and suggestions.

Contact Details :

VIVA USA INC.
3601 Algonquin Road, Suite 425
Rolling Meadows, IL 60008