HEDIS
: Job Details :

A large well known managed care organization is hiring an LPN with HEDIS and Chart chase/ DSNP, and Quality experience for an Onsite position in the San Antonio area. Mon-Fri- 8-5 CST, after hours and Weekend work may be required

Required Qualifications: • Licensed Practical Nurse • Minimum 2 year HEDIS experience and/or knowledge • Solid knowledge of managed care requirements related to clinical quality • Strong medical record review and abstraction prefer • Research and detail oriented, excellent proof reading skills • Excellent time management and prioritization skills • Strong communication skills • Strong proficiency with Microsoft Office applications, including: Word, Excel, Adobe and PowerPoint • Critical thinking skills • Results-driven independent worker, and self-starter

HEDIS Operations combines talented individuals from many areas of quality, including HEDIS, CAHPS and Accreditation. Our goal is extraordinary performance that exceeds the expectations of stakeholders, customers and members we serve. In this position, you will work with the Quality SDS/PSV Operations staff to assist with data collection of DSNP data. The purposes of this role include but are not limited to: 1\. Market specific data entry and collection 2\. Medical record review and abstraction for HEDIS and HEDIS-like measures 3\. Other duties as assigned 4\. Datamining The candidate must be technically savvy and must be able to work without distraction. This is a high production environment, and candidates must adhere to measured productivity and quality requirements. Essential Job Functions 1\. Assisting in the review of medical records to highlight Star/HEDIS opportunities for the medical staff. 2\. Review medical records for data collection, data entry, and quality monitoring that close gaps in care. 3\. Partner with the leadership team, the practice administrative or clinical staff to identify trends observed and potential strategies to support the practice. 4\. Communicate challenges or trends that may negatively impact quality outcomes. 5\. Track and trend barriers/challenges that exist at their assigned groups so that better outcomes can be achieved including access to appointments lack of follow up on referrals, or inconsistent coding practices. 6\. Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures. 7\. Support quality initiatives by requesting medical records from provider's offices as needed. 8\. Receives and responds to incoming Clinical Quality inquiries from all communication venues: e.g. phone and fax queue, TruCare, or department e-mail box. 9\. Conducts in-bound and out-bound calls for quality requirements including, but not limited to: medical records requests, contact verification. 10\. Provides clerical and/or administrative support to quality staff and managers for special projects and reporting needs. 11\. Provides excellent customer service by serving as a resource to all internal and external customers. 12\. Maintains education/knowledge base of HEDIS/STARs. 13\. Datamining Responsibilities: • Reviews assigned medical records in order to verify clinical data elements for HEDIS reporting, • Identifies findings supported by documentation guidelines with high level of accuracy • Maintains HIPAA standards and confidentiality of protected health information; reports critical incidents immediately. Prioritize and organize own work to meet agreed upon deadlines. • Communicates identification of pursuit leads for additional medical records, if needed, to other members of the team • Attends conference calls as necessary to provide information relating to clinical reviews and compliance • Successfully completes HEDIS technical specification training and testing • Successfully completes HEDIS software training and uses software correctly • Performs other duties as assigned