Medical Records QA Specialist (2852BR) Long Beach, California

Molina Healthcare - Medical Records QA Specialist

Job Summary

The Medical Records QA Specialist will review medical records and performs assessments to determine errors in the records.

Essential Functions

• Reviews medical records and identifies gaps against national Molina standards
• Identifies gaps against external auditor standards (where different)
• Performs simple assessments calculations to determine if errors are a pattern or one-off typos
• Escalates errors to Mgr, AVP and VP in timely way so corrective actions can be considered

Knowledge/Skills/Abilities

• Ability to manage quality work and to enforce quality healthcare throughout the organization (developing).
• Ability to identify barriers to quality healthcare and/or gaps in process that interfere with delivery of quality healthcare (entry level).
• Ability to demonstrate strength in strategic and analytical thinking, problem solving, and presentation skills (developing).
• Ability to demonstrate strength in teaming and interpersonal skills, and the ability to initiate and maintain cross-team relationships (entry level).
• Ability to meet mission-critical deadlines and to motivate staff to meet these deadlines; proven ability to manage personal stress and those of staff through proactive management and emotional intelligence skills (developing).
• Ability to expertly manage projects, including the ability to manage people and time resources and the ability to monitor the effectiveness of activities (developing).
• Ability to demonstrate expert organizational skills (developing).
• Ability to demonstrate mastery of multiple healthcare knowledge areas, including clinical, coding, business operations, and IT analytics. Mastery of common programming languages (SQL, SAS, etc.) and low-level facility with programming concepts desirable (entry level).
• Ability to maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) (proficient).

Required Education:
High School Diploma or equivalent

Required Experience:
• 1+ years of health plan experience
• 1+ years of medical record review experience

Required Licensure/Certification/Associations:
 
Preferred Education:
Clinical degree highly preferred, including, but not limited to, RN, LVN, CCC, MA, RHIT, EMT, LCSW

Preferred Experience:
• 1+ years of HEDIS medical records review experience

Preferred Licensure/Certification/Associations:
CPHQ

To all current Molina employees if you are interested in applying for this position please apply through the intranet job listing. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online.

Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
To apply, please click here