Job Summary

Molina's Quality Improvement Sr. Overreader conducts oversight and audits of the data collected and abstracted from medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The overreader team will meet chart overread productivity standards, minimum over read standards, and 2nd overread standards to ensure accuracy of their audit skills. Sr. Overread team members will mentor new overread team members and assist with ad hoc projects.

Job Duties

• Performs the role of the HEDIS medical record review overreader/auditor which includes ongoing review of records reviewed and data entered by the abstraction team during the annual HEDIS medical record review as well as all other HEDIS/HEDIS like project. Mentors entry-level Overreaders throughout the process.
• Provides feedback to providers on visit notes or feedback from the HEDIS audit. Makes recommendations based off of the audit and chart review.
• Assists with ad hoc projects.
• Participates in scheduled meetings with the Abstraction team, National Training Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results.

Job Qualifications

REQUIRED EDU C A TI O N:

Bachelor's degree or equivalent experience

REQUIRED EXPER I E N CE/KNOWLEDGE, SKILLS & ABILITIES:

• 5 years experience in healthcare Quality/HEDIS specific to abstraction and overreading.

PREFERRED EXPER I E N CE:

• At least 3 years of medical record abstraction experience and at least 2 years experience in the overread role.
• 3+ years managed care experience.
• Advanced knowledge of HEDIS and NCQA.

PREFERRED LI C E N SE, C ERTIFIC A T ION, ASSOC I A TI O N:

Active RN license for the State(s) of employment

PHYS I CAL DEMA NDS:

Working envir o nment is ge nerally fa vo rable and lighti ng and tem perature are adequate. W ork is generally perfo r med in an office e n vir o n ment in w hich t here is o n ly minimal exp osure to unpleasant and /or hazard o us w orking co nditio ns. M u st h a ve the ability to sit for lo ng perio ds. Reas o nable accom mo d atio ns m ay be made to e nable ind i viduals with disabilities to perf o rm t he essential functio n.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.