Note: The job is a remote job and is open to candidates in USA. Cohere Health is a company that delivers AI-powered solutions to streamline access to quality care. They are seeking a detail-oriented and certified HEDIS Clinical Terminologist to validate automated measure results and support quality improvement efforts through medical record data analysis.

Responsibilities

• Review EHR and PDFs of medical records to collect HEDIS conformant data elements.
• Be able to validate that our automated solutions are pulling and coding the data appropriately with respect to diagnosis, procedures and services (ICD10, HCPCS, CPT, SNOMED, LOINC)
• Adhere to NCQA technical specifications for each HEDIS measure.
• Familiarity with measure sets like Adult BMI, Breast Cancer Screening, Colorectal Cancer Screening, and CDC measures.
• Remain current on NCQA reporting standards and evolving measures
• Abstract and code clinical data from medical records in a HEDIS and STARS conformant manner.
• Understand evolving measure criteria, keep current on measure specifications and evaluate clinical documentation to determine compliance with specific HEDIS measure criteria.
• Work with data and clinical teams to validate clinical and informatics intent.
• Identify and flag unexpected and discordant technological outcomes supporting opportunities for product improvement.
• Participate in audits, quality assurance and product improvement activities as needed.
• Ensure confidentiality and compliance with HIPAA and company policies.

Skills

• 2+ years of recent HEDIS abstraction experience, including familiarity with STARS measures.
• Strong clinical acumen with the ability to translate clinical information into codified concepts (e.g.ICD10, HCPCS, CPT, SNOMED, LOINC) - LPN, RN, or Medical Assistant.
• Strong knowledge of NCQA HEDIS guidelines, CMS STARS specifications, and risk adjustment.
• Experience using HEDIS abstraction tools.
• Review EHR and PDFs of medical records to collect HEDIS conformant data elements.
• Be able to validate that our automated solutions are pulling and coding the data appropriately with respect to diagnosis, procedures and services (ICD10, HCPCS, CPT, SNOMED, LOINC).
• Adhere to NCQA technical specifications for each HEDIS measure.
• Familiarity with measure sets like Adult BMI, Breast Cancer Screening, Colorectal Cancer Screening, and CDC measures.
• Remain current on NCQA reporting standards and evolving measures.
• Abstract and code clinical data from medical records in a HEDIS and STARS conformant manner.
• Understand evolving measure criteria, keep current on measure specifications and evaluate clinical documentation to determine compliance with specific HEDIS measure criteria.
• Work with data and clinical teams to validate clinical and informatics intent.
• Identify and flag unexpected and discordant technological outcomes supporting opportunities for product improvement.
• Participate in audits, quality assurance and product improvement activities as needed.
• Ensure confidentiality and compliance with HIPAA and company policies.
• Previous experience working with Medicare Advantage or managed care organizations.
• Familiarity with electronic health record (EHR) systems and data abstraction from unstructured sections of their documentation.
• Familiarity with HEDIS primary source verification and HEDIS audit processes.
• Previous experience abstracting appropriate clinical data elements, and applying conformant ICD-10, CPT, and HCPCS codes supporting NCQA and CMS STARS conformant measurement capture.
• Previous experience or familiarity with risk adjustment.

Company Overview

• Cohere Health is a SaaS company that focuses on improving the efficiency and effectiveness of healthcare delivery. It was founded in 2019, and is headquartered in Boston, Massachusetts, USA, with a workforce of 501-1000 employees. Its website is https://coherehealth.com.

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