Medical Record Reviewer - LPN

Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.   

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.

Responsibilities and Qualifications

• Review patient records to ensure documentation aligns with medical, legal, regulatory, and insurance standards.
• Abstract appropriate supporting documentation into abstraction tool.
• Support audits for internal quality control or external compliance (e.g., Medicare/Medicaid, insurance carriers).
• Collaborate with healthcare providers or internal staff to clarify unclear or incomplete documentation.

Education and Certifications:

• Must have active Licensed Practical Nurse (LPN) license.

Experience:

• 1-2 years of medical record review experience required.

Knowledge:

• Knowledge of Facets, Excel and various software used for medical record abstraction documentation. Medical Terminology
• Proficient in using electronic health records (EHR).

Skills:

• Ability to communicate effectively and professionally, both verbally and in writing with various audiences.
• Ability to plan, organize and coordinate multiple tasks and priorities.
• Ability to perform duties with minimal supervision. Includes the ability to act both independently and as part of a team while adapting to changing priorities.
• Analytical skills

 

About Us

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 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. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.