Clinical Abstraction Specialist

Summary

The Clinical Abstraction Specialist reports to the Manager of Clinical Abstraction Services. Under general supervision and within Brown University Health established policies and procedures, manages coordination and implementation of duties associated with the abstraction of clinical quality data for public and other reporting through the national quality initiatives for all Brown University Health affiliates.

Responsible for accessing medical records information for the purposes of completing clinical abstraction.

Manages abstraction workflow and monitors abstraction and reporting deadlines including but not limited to data submission due dates for The Joint Commission (TJC) core measure reporting and CMS requirements.

Monitors changes and additions in quality reporting measures, specifications, and rules of abstraction to ensure measurement standards of Hospital quality program, The Joint Commission (TJC), Centers for Medicare and Medicaid (CMS) and other regulatory agency requirements are met.

Supports the care team and Medical Staff in the identification of care opportunities and facilitates improvement activities. Serves as liaison between certified related vendors and/or outsourced abstraction services.

Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

Responsibilities

Accesses vendor abstraction tools, including reporting options, and the clinical warehouse for data reporting to ensure accuracy of data reports through rate verification during preview periods and the validation process. Submits corrections or appeals as directed.

Supports the clinical data abstraction and management process for clinical quality measures, i.e. vendor issues and deadlines, system maintenance, training and scheduling, monitoring data for accuracy and verification. Completes and supports work assigned to the project team for specific task assignments including data management, medical record coordination, and abstraction, in accordance with HIPAA regulations.

Facilitates team activities such as team meetings to communicate indicator changes, data collections issues, specification updates and interpretation, medical record changes or additions. Must stay abreast of all concurrent and ongoing changes to abstraction rules, populations, public reporting requirements, and adherence to outlined information flow both internally and externally.

• Serves as a resource for internal customers to understand data collection specifications, documentation requirements, data interpretation to facilitate improvement activities. Participates in group and project activities for process improvement as directed.
• Notifies manager of changes in trends or results associated with performance levels and/or compliance with evidenced-based care in real-time.

Assists in identifying gaps in documentation that impact accuracy or measured performance on required measures of performance. Aligns goals of abstraction services with upstream documentation and clinical services workflows, identifies gaps as opportunities for improvement.

Supports technical training programs aimed at performance improvement. Ensures that all abstraction work is accurate and complete, and communicates, coaches and trains as required to standards to assist peers. Implements processes (as directed) aimed at measuring accuracy of completed abstraction of assigned measures and completes audits that measure effectiveness of teamwork flow and accuracy as required.

• Facilitates and coaches teams working to improve performance.
• Coordinates and supports the implementation of improvement tactics in alignment with organizational priorities.
• Notifies the Manager of Abstraction Services when issues arise and takes corrective action as needed.
• Performs other duties as assigned.

Minimum Qualifications

• Bachelor's Degree or equivalent in nursing or other healthcare related field is required.
• Master's Degree in health care or health science discipline preferred.
• Certified Professional in Healthcare Quality (CPHQ) is preferred.
• Certification in Lean/Six Sigma (Green Belt or Black Belt) and TapRoot methodologies is required or must be attained within first 24 months of working in position (provided on-site).

Experience

• Two or more years of relevant experience in chart abstraction, measurement support, technical training, education, facilitation and best practice identification preferably in a large complex healthcare organization.
• Knowledge of problems, activities and causes related to provision of clinical care and of methods of quality assessment.
• Knowledge of federal, state and voluntary quality management regulations and standards.
• Must possess excellent verbal and written skills, ability to be self-directed and obtain current quality initiative and specification details from federal and state manuals.
• Expertise with access and understanding to of data sources such as medical records, financial data, department/service specific data, and various Brown University Health-wide manual and automated data systems.
• Demonstrates technical knowledge of the Specification Manual for National Hospital Quality Measures and other data specification manuals as relevant to assigned areas of abstraction responsibility.

Work Environment and Physical Requirements

Work is performed in a typical office setting, requiring extensive periods of sitting, with arms extended as well as walking and standing.

Independent Action

• Performs independently within the department policies and procedures; refers specific problems to the Director where clarification of departmental policies and procedures or workload may be required.
• SUPERVISORY RESPONSIBILITY: None.

Pay Range

$86,382.40-$142,542.40