Medical Record Reviewer-LPN/RN

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” The position will complete review and abstraction of medical records utilized for annual HEDIS submission. The reviewer will be required to track data submission and inform management of any trends, barriers, or backlog. The position requires interpretation of clinical data submissions in order to accurately submit records for processing or return the records to the submitter in a timely manner with detailed return reasons. Other responsibilities may include medical record retrieval either onsite or via remote access throughout the year, participation in annual HEDIS hybrid record processes, involvement in Health Outcomes Improvement Team initiatives, training temporary staff as applicable to assist in chart abstraction process, and meet departmental goals of timely and accurate review of medical records.

Review medical records and abstractions from various modes of submission. Communicate with providers and internal staff to improve processes and submissions accuracy. Attend appropriate trainings related to HEDIS and medical record review/abstraction. Other duties as assigned