Job Description:Pay Range: $34hr - $39hrEssential Functions:
- 50% Accurately and efficiently over-read medical record abstractions performed by the HEDIS abstraction staff on a daily basis according to HEDIS specifications and company training guidelines.
- Complete the over-read process in the Software Application, including comments if errors are found.
- Correct errors identified through over-read process, including a re-review of charts that may contain similar errors.
- Identify and report abstraction errors and provide measure re-education with the abstractor.
- Utilizes various software applications to support HEDIS operations by entering data and / or changing chase status for the identified chase(s).
- Maintains productivity level as determined by the QI Department.
- Maintain compliance with all HIPPA and member confidentiality requirements.
- 25% Medical Record Retrieval, Abstraction and Research during the Medical Record Review Project.
- 25% Medical Record Retrieval for Risk Adjustment, internal Supplemental Data Audit (PSV) and other Quality and HEDIS related tasks in the off-season.
Experience:
- 3 years clinical experience, and 5 years HEDIS and Overread experience.
- In Lieu of Education.
- 10 years of recent HEDIS abstractions / overreads experience in the payer/health insurance side of HEDIS or with a HEDIS vendor (ex. Cotiviti, Inovalon, Reveleer),
Preferred Qualifications:
- Bachelor's degree in Nursing, Associates Degree in Nursing, Diploma in Nursing.
- At least two consecutive HEDIS seasons with the same company.
Knowledge, Skills and Abilitie:
- Ability to effectively communicate and provide positive customer service to every internal and external customer - Proficient.
- Strong interpersonal skills. Ability to work independently, as well as a member of a team - Advanced.
- Current knowledge of clinical practices related to HEDIS and Medical Record Review - Advanced.
- Strong organizational skills, ability to prioritize responsibilities with attention to detail. - Proficient.
- Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and web-based technology - Proficient.
- Must possess excellent verbal and written communication skills - Advanced.
- We are seeking a qualified RN/LPN with experience in HEDIS reporting and overread processes..
- The ideal candidate will have a robust understanding of healthcare quality metrics and a proven track record of accurate data abstraction and interpretation.
- Applicants must be detail-oriented and able to work independently while maintaining a high level of accuracy.
- Prior experience in HEDIS and overread review is essential for this role.