About the role
Role Description The Intake – Chart Retrieval QRM Associate is responsible for reviewing, validating, and processing medical records to support quality review and case management activities. This role requires a high level of attention to detail, strong analytical skills, and the ability to work efficiently across multiple applications while ensuring compliance with HIPAA, client requirements, and NCQA standards.
Key Responsibilities
- Collaborate closely with Registered Nurses (RNs), Medical Coders, and multidisciplinary healthcare professionals to ensure seamless communication and accurate case management
- Review retrieved medical records to verify that they are legible, complete, and accurately matched to patient identifiers, including name, date of birth, dates of service, provider, and facility information
- Handle all Protected Health Information (PHI) with strict confidentiality while ensuring full compliance with HIPAA regulations and client security protocols
- Analyze received medical records and file data to determine the appropriate clinical pathway and next steps
- Route cases to the appropriate clinicians based on urgency levels (urgent versus non-urgent) to ensure adherence to established turnaround times (TATs) and NCQA standards
- Maintain accuracy and consistency when working with patient records and clinical documentation across various Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems
- Utilize Microsoft Excel to organize and maintain departmental files, track case status, and produce accurate weekly reports
- Perform quality checks to ensure medical records meet client and organizational requirements
- Manage multiple priorities and applications while maintaining productivity, accuracy, and service-level expectations
Qualifications
- Any college education
- At least 6 months of Healthcare BPO work experience
- Ability to multitask across multiple applications
- Strong analytical skills with excellent attention to detail
- Great team player with excellent interpersonal skills
- Amenable to 6 months contract
Successful hires will be asked to provide NBI clearance, Former Employment documents among others
Skills HIPAA, Microsoft Excel, Healthcare Systems, Reporting and Analytics
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