Location: Baltimore,MD, USA
Job Title: Clinical Medical Review – Quality Specialist
Location: Baltimore, MD 21224
Duration: 9+ Months Contract
PURPOSE:
The Quality Specialist – HEDIS (RN/LPN with clinical experience) will report to the Clinical Support Supervisor – HEDIS and be part of the Quality Team. Their main duties include chart retrieval and conducting thorough medical record reviews using proprietary tools and software. The role requires extensive knowledge of HEDIS measures to accurately and promptly abstract medical records for gap closure and other data collection, all while adhering to HIPAA Privacy and Security standards. Responsibilities also include retrieval follow-up and escalating issues as needed. Expertise in HEDIS and Quality Measures is used to meet productivity and quality targets, enhance measure compliance, and improve rate submissions according to NCQA guidelines and technical specifications.