Evaluates the quality of health care services ordered or performed by Geisinger's professional health care providers including medical audits, ambulatory care reviews and the compliance of Geisinger with standards set by associations of health care providers and with applicable laws, rules and regulations. Evaluates the quality of health care rendered requested by external agencies with applicable laws, rules and regulations.
Performs duties to support the goals and objectives of the Geisinger and the Division of Quality and Safety in its efforts to provide quality patient care, patient satisfaction, and continuous improvement. Performs all duties in a manner that promotes team work.
Reports to the Manager Quality Measurement and Reporting or the Manager Regulatory Performance Improvement (Geisinger Medical Center).
MAJOR DUTIES AND RESPONSIBILITIES:
All duties of the employee are solely for the purpose of Peer Review pursuant to 63 P.S. § 425.1 et seq and/or the MCARE Act, PSQA of 2005, and include, but are not limited, to the following:
*1. Performs medical record audits.
*2. Collects, organizes and analyzes data and provides findings to the appropriate committees as defined by the Division of Quality and Safety.
*3. Conducts ongoing medical record review audits in compliance with the Joint Commission standards, Department of Health Regulations and department policy.
*4. Conducts focused open and closed medical record review audits
*5. Conducts audits to comply with the Joint Commission and Root Cause Analysis Measures of Success as required.
*6. Conducts medical record and/or EHR audits in compliance with Joint Commission Oryx Core measure standards
*7. Enters data into MIDAS+ database, audits and generates reports from the database.
*8. Reports any potentially liable situation found during utilization management activities.
*9. Attends educational meetings relating to Performance Improvement as requested.
*10. Maintains working knowledge of CPT and ICD-10 coding principles as applicable.
*11. Attends and participates on appropriate committees.
*12. Attends to and assures the utmost integrity of the data, the data collection processes, and measurement for optimal accuracy rate.
*13. Treats all internal and external information with strict confidentiality.
*14. Performs internal studies and projects as assigned within established time frame.
*15. Completes work assignments within established time frames and functions with minimal supervision and assumes responsibility for daily and month end audits.
*16. Understands and complies with regulations and recommendations of outside regulatory bodies pertaining to Performance Improvement; i.e., the Joint Commission, DOH, and CMS.
*17. Makes appropriate suggestions and/or recommendations to resolve identified issues, streamline processes and improve efficiencies within the department and/or hospital.
*18. Interacts appropriately with physicians, provides information, suggests alternatives, and assists in assuring data integrity.
19. Actively participates in patient safety improvement and management program. An active participant: a. Assumes responsibility for identifying processes or systems that could potentially lead to errors and adverse events. b. Knows and follows organizational and departmental policies and procedures applicable to assigned duties. c. Participates in required organizational and departmental patient safety education programs and other activities designed to improve departmental and organizational patient safety. d. Promptly reports serious events and incidents in accordance with established hospital policy and procedure.
20. Performs other duties as required or assigned by emergency or other operational reasons for which the employee is qualified to perform.
*Denotes essential job functions.
COMPETENCIES AND SKILLS:
Demonstrates basic computer skills. Demonstrated ability to use Microsoft Office products and GroupWise.
Demonstrates ability to communicate and write effectively.
Demonstrates exceptional ability to work independently and as a team member.
Demonstrates ability to function with minimal supervision.
Demonstrates exceptional ability to retrieve and research clinical information.
Demonstrates ability to review complex clinical documentation for sustained periods of time with a high concentration level.
Demonstrates knowledge of mathematical calculations.
Demonstrates strong organizational skills.
Demonstrates knowledge of medical terminology and the ability to review a medical record.
EDUCATION AND EXPERIENCE:
LPN with a current PA license required.
Minimum three years acute care hospital experience required.
Proficiency with MIDAS software preferred.
Experience with Performance Improvement programs preferred.
Experience with CPT, ICD-10, and Medical Terminology preferred.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in an office environment. Requires ability to stand, walk, and sit, for extended periods of time, with high levels of concentration. Requires ability to use a computer and carry a laptop computer. Travel within Geisinger may be required.
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
ABOUT GEISINGER: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family.
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. * Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.
** Does not qualify for J-1 waiver. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
*Domestic partner benefits not applicable at Geisinger Holy Spirit.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.