Medical Record Reviewer

Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

The position will complete review and abstraction of medical records utilized for annual HEDIS submission. The reviewer will be required to track data submission and inform management of any trends, barriers, or backlog. The position requires interpretation of clinical data submissions in order to accurately submit records for processing or return the records to the submitter in a timely manner with detailed return reasons. Other responsibilities may include medical record retrieval either onsite or via remote access throughout the year, participation in annual HEDIS hybrid record processes, involvement in Health Outcomes Improvement Team initiatives, training temporary staff as applicable to assist in chart abstraction process, and meet departmental goals of timely and accurate review of medical records.

Responsibilities And Qualifications

• Review medical records and abstractions from various modes of submission.
• Communicate with providers and internal staff to improve processes and submissions accuracy.
• Onsite or remote medical record retrieval.
• Attend appropriate trainings related to HEDIS and medical record review/abstraction.
• Other duties as assigned
  
  

Job Requirements

• Ability to communicate effectively and professionally, both verbally and in writing with various audiences. Ability to plan, organize and coordinate multiple tasks and priorities.
• Ability to perform duties with minimal supervision. Includes the ability to act both independently and as part of a team while adapting to changing priorities.
• Analytical skills
• Knowledge of Facets, Excel and various software used for medical record abstraction documentation.
• Medical Terminology
  
  

Experience

• Varied clinical experience, 1-2 years of medical record review experience.
  
  

Education, Certification, And Licenses

• LPN required
  
  

Work Environment: Office

Travel Requirements: 1% Possible travel for medical record retrieval.

Physical Demands

• While performing the duties of the job, the employee is frequently required to sit, use hands to finger, handle and feel, and talk, hear, and see.
• The employee must occasionally lift and/or move up to 5 pounds.
  
  

Key Interfaces: Internal departments and external providers

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.

And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.

Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. We are an equal opportunity/affirmative action employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law.