Excellus BlueCross BlueShield RN or CPC Per Diem Clinical Reviewer-multiple positions (Syracuse, Binghamton,Watertown) in Syracuse, New York
The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.
Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.
OUR COMPANY CULTURE:
Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.
This position requires abstraction of data from Medical Records to support accreditation programs to meet regulatory requirements and to help improve quality outcomes for the Health plan. The more seasoned Reviewer may be accountable for auditing the junior Per Diem Clinical reviewer staff abstraction of data and data entry from Medical Records to support accreditation programs, to meet regulatory requirements and to help improve quality outcomes for the Health plan.
Accurately and efficiently conducts medical record review, including but not limited to, HEDIS/QARR, CMS (Centers for Medicare and Medicaid Services), DOH requests, Pre-natal/Postpartum Reporting, and ad hoc requests from Medical Directors or other departments in Health plan.
Successfully completes required training, testing and quality assessments.
Travels from home to provider offices or facilities to complete reviews, as required.
Abstracts data from medical records, uses portable scanner to retrieve relevant components from medical records and upload scanned medical records daily, as required.
Maintains daily communication with management.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular reliable attendance is expected and required.
Performs other functions as assigned by management.
Travels from home to provider’s offices or facilities to oversee junior level staff, as required.
Audits abstracted data from medical records and data entry from junior staff for accuracy.
Communicates accuracy findings to junior staff and Management.
RN with current New York State License and a minimum of three years of progressive clinical experience or Certified Professional Coder (CPC) with a minimum of 6 months coding experience required. Electronic Medical Record/Electronic Health Record experience preferred.
A minimum of one year HEDIS experience preferred.
Strong computer skills with access to high-speed internet service.
Professional, articulate and able to work independently. Ability to multi task and trouble shoot problems independently.
Ability to manage and meet deadlines.
Business attire required when visiting provider offices/facilities. Wears Health Plan ID Badge at all times.
Must be available and accessible during business hours.
Must be capable of day travel
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer