POSITION DESCRIPTION

TITLE: Performance Measurement Audit Assistant

DIVISION/DEPARTMENT: Performance Measurement

PREPARED BY: Conni Brandt [ X ]Exempt or [ ]Hourly

FTE: 1.0

DATE: 9/28/2017

POSITION SUMMARY

Reports to: Performance Measurement (PM) Vice President

Regularly works with:

PM Vice President

Auditors

PM Administrative Assistant

PM Project IVA Lead

PM Business Analyst

Subcontracted staff

Health Plans contracted with MetaStar

Medical Coding Vendors

IT staff

Other MetaStar department staff

Positions that report to this position: none

Key responsibilities:

1.  Participates in all Initial Validation Audit (IVA) activities

a.  Conducts demographic and enrollment validation

b.  Performs medical record coding abstraction and complies with official coding rules and guidelines

c.  Conducts medical record overreads and performs inter-rater reliability per IVA requirements

d.  Assists with Issue Log processing

e.  Participates in tool and document development for IVA

  1. Manages documents on the audit SharePoint site
  2. Monitors and updates timelines on the audit SharePoint site
  3. Facilitates communication with vendor partners
  4. Communicates with health plans regarding audit findings
  5. Maintains the audit online folder structure
  6. Assists auditors with HEDIS, DV, and URAC audit tasks as necessary.
  7. Assists with Standard Operating Procedure creation and updates.
  8. Promotes positive internal and external communication and positive teamwork.
  9. All other duties as assigned.

CORE ORGANIZATIONAL COMPETENCIES

Teamwork: Demonstrates respect and achieves cooperative relationships in fulfilling the vision and mission of MetaStar.

Communication: Demonstrates good interpersonal skills with all whom they interact. All communications, verbal and written, should demonstrate a commitment to customer service and excellence. Effectively sends, receives, and responds to requests while maintaining a high level of confidentiality.

Initiative: Committed to and performs quality work contributing to the vision and mission of MetaStar. Assumes responsibility and accountability for his/her actions. Meets the challenges of a changing environment, is timely in meeting job responsibilities and strives to provide excellent customer service. Values accomplishments and shows enthusiasm and pride in the organization. Demonstrates a self-directed work effort. Develops goals for professional growth and strives to achieve those goals.

Customer Service: Demonstrates a commitment to courteous, sincere, and sensitive customer service. Presents a positive and caring attitude in all interactions. Is patient, tolerant, accepts diversity and presents a positive image of themselves and MetaStar in all personal and telephone interactions.

Quality Improvement: Demonstrates a commitment to quality and excellence. Solves problems through critical evaluation of data-based information and continuous improvement efforts. Can accurately identify and diagnose issues, identify alternatives, implement a plan, evaluate and communicate results.

QUALIFICATIONS:

  1. At least five years of coding certification with AHIMA or AAPC required
  2. Bachelor’s or Associates degree preferred
  3. At least two years of health plan risk management experience preferred
  4. Proficient in the use of computer applications, including Microsoft Word and Excel. Microsoft SharePoint experience preferred
  5. Excellent attention to detail
  6. Excellent verbal and written communication skills

7.  Ability to effectively prioritize multiple priorities

  1. Ability to work well independently and within a team structure