Medical Records Coordinator Jobs

Job Summary

The Medical Records Coordinator is responsible for supporting quality improvement and compliance initiatives that support best practice in care and service excellence for Empower’s members and providers. This includes involvement in quality projects/initiatives and in the end-to-end quality review process inclusive of clinical and service indicators, data sampling, file extraction, analysis, trending, and reporting of results.

Duties/Responsibilities:

• Leads the medical record review portion of HEDIS audits.
• Supports the HEDIS® chart retrieval process including chase tracking, provider outreach, claims research, faxing and issue resolution acronyms.
• Is an integral participant of the:

o quality of care and service review process,

o the medical record documentation review process for delegation and network/provider oversight,

o quantitative and qualitative analysis of data, and

o reporting of process and care results.

• Perform records collection as defined by Compliance and/or Quality departments
• Performs provider records review against clinical and documentation guidelines in the determination of compliance with standard of care, contract, and state requirements.
• Work with quality improvement department staff to ensure reporting requirements and timelines for production of reports.
• Participate in implementing / maintaining operational processes to promote compliance with Empower’s policies, legal requirements, and regulatory mandates.
• Documentation review results and education, when needed, are made available to providers and selected entities according to defined policy and procedures.
• Other duties as assigned.
• Collaborates with Compliance, Utilization Management, Provider Management and other Empower stakeholders regarding clinical records documentation and review outcomes.
• Performing medical record reviews to support valid study results using applicable criteria and methodology (sampling, randomization, etc.) to identify member or provider records, and indicators for reviews.
• Develops templates/formats for data collection and reporting to the Credentialing and Quality Committee.
• Extraction of required elements from paper and EMRs, according to pre-defined requirements.

Required Skills/Abilities:

• Analysis of complex data to:

o Identify opportunities to improve quality outcomes.

o Identifies challenges and barriers to performance improvement and

o Works collaboratively to find successful solutions.

• Advanced Excel skills, especially graphing data over time and coaching colleagues in understanding the science of improvement, are essential.
• Excellent organizational, critical-thinking, verbal and written communication skills required
• Ability to work independently under general instructions, display initiative, be self-directed and motivated.
• Excellent interpersonal, assertive, and diplomatic communication skills with the Empower team, providers, and members.
• Strong logic skills and decision-making abilities
• Positive presentation skills to enable demonstration of data and results to Empower senior staff or providers as directed by management.
• Able to provide own transportation when the collection of medical records may require the extraction on site.
• Strong critical thinking/analytic skills, the ability to use data to drive improvement activities, and strong organizational and prioritization skills

Education and Experience:

• Registered Nurse license in the state(s) of practice without restrictions
• 3-5 years of Quality Management and/or UM in a managed care environment
• Must be able to work effectively and collaboratively within a team
• Strong clinical background as an RN (minimum of 5 years).
• Bachelors Degree in Nursing or Health related field from an accredited program