Quality Documentation Retrieval Specialist

2 weeks ago

Karachi Defence Housing Society, Pakistan Mac Care Full time

Summary

The Quality Documentation Retrieval Specialist will play a key role in supporting IntraCare's Population Health and Quality Improvement initiatives. This position focuses on identifying mammogram-related procedures in claims data, locating corresponding clinical reports within EMRs, and coordinating with imaging centers to obtain missing documentation.

The role ensures that all quality-related documentation is complete and accurately sent to provider offices to close care gaps in compliance with HEDIS, STARs, and payer quality program requirements. The role may also require direct patient outreach when needed.

The Quality Documentation Retrieval Specialist reports to the Director of HEDIS and Payer Quality Performance and works closely with the Quality, Data, and Practice Support teams to drive performance in preventive care measures.

Key Responsibilities

  • Review claims and quality data to identify patients with mammogram procedure codes lacking corresponding report documentation in the EMR.
  • Search EMRs (eClinicalWorks, Athena, NextGen, etc.) to locate mammogram reports, imaging notes, or related results.
  • Contact imaging centers and diagnostic facilities to request copies of completed mammogram reports for identified patients.
  • Contact patients directly when required.
  • Verify and document all outreach attempts, report requests, and received results within designated tracking tools or databases.
  • Upload and route received imaging reports to the appropriate provider or clinic according to HIPAA-compliant procedures.
  • Maintain meticulous tracking logs of pending and completed retrievals to ensure timely resolution of all cases.
  • Collaborate with practice and population health staff to resolve documentation discrepancies.
  • Report progress and barriers to the Quality Team Lead or Manager regularly.
  • Maintain confidentiality and adhere to HIPAA and organizational data protection standards.
  • Other duties as assigned to support the Quality and Population Health teams.

Required Qualifications

  • High School Diploma or GED required.
  • Excellent verbal and written communication skills, including professional telephone etiquette.
  • Strong organizational and time management abilities; capable of handling multiple outreach requests simultaneously.
  • Proficiency with Microsoft Excel and Word.
  • Basic understanding of healthcare processes and terminology.
  • Ability to navigate EMRs and retrieve relevant medical documents.
  • Demonstrated reliability and attention to detail.
  • Ability to work independently and meet daily productivity targets.

Preferred Qualifications

  • Experience in medical record retrieval, chart abstraction, or quality documentation support.
  • Familiarity with HEDIS and CMS quality measures (especially Breast Cancer Screening).
  • Prior experience working in or with imaging centers, radiology departments, or provider offices.
  • Knowledge of payer reporting requirements and quality programs (Medicare Advantage, MSSP, etc.).
  • HIPAA compliance training or certification.

Job Type: Full-time

Work Location: In person

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