NTT DATA Services currently seeks a HEDIS Reviewer to join our team in Illinois. This is a work from home role but must live in the state of ILParticipates in the review of medical records to abstract clinical information for HEDIS reporting. May require travel to physician offices.Role Responsibilities- Interprets relevant clinical criteria and/or medical policy/benefits for an identified case. Determines when to consult appropriate provider or practitioner and to review case with medical Director for additional action.- Ensures accurate and complete documentation of required information to meet risk management, regulatory, and accreditation requirements.- Prepares and reports business information to internal and external constituents. Consults with the constituents on solutions to business issues.- Identifies trends involving clinical issues and reports/recommends solutions to senior management and others.- Conducts audits and/or assessments to determine compliance with guidelines. Identifies gaps and May assist in the development/re-evaluation of corrective action plans.Required Skills/Experience
- 2+ years audit or related business experience required.
- 2+ years Clinical Experience
- 2+ years Managed Care experience
Education: Verifyable High School Diploma or GED. Nursing license preferred but not required. Successful HEDIS review experience may be substituted for licensureHours: Monday-Friday 8am -5pm CSTAbout NTT DATA Services:NTT DATA Services is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is $27.25 per hour. This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications.This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits.#INDHRS