HEDIS Reviewer III

Ask Staffing

Not Specified, United States Full-time in Healthcare & Medical
    • Job ID 1493055

    Job Description

    We have 2, pre-selected candidates for this requisition

    Position requires advanced degree and licensing. BSN preferred
    RN active and in good standing License required. the license is required, the type can be RN (preferred) or LPN (would need great experience).

    MAX Bill Rate – $59.64

    HEDIS medical record reviewer for the HEDIS MY2023 Audit. The nurse reviewer will attend training provided by Mercy Care/Aetna on required data needed to meet compliance for specific Hybrid HEDIS measures. Data will be retrieved from medical records obtained through a variety of methods. Position requires flexibility and the ability to work under pressure to meet hard deadlines. Qualified candidates will possess a professional demeanor and have a strong work ethic, be self-motivated, a conscientious problem solver, willing to learn, and take personal pride in their work performance/accuracy. Ideal candidates will have 3 years of HEDIS record abstraction experience, proven organizational and time management skills, experience in a work-from-home scenario, and excellent verbal communication skills clear, concise, and professional. Must be computer savvy with working knowledge of Microsoft Excel, Outlook, and Adobe preferred. Candidate must be able to commit to duration of the project.

    -Review, abstract and data enter all medical record data obtained via paper, electronic, CD, fax or mail -Name and file medical record documents electronically, maintaining member PHI and PII -Fax medical record requests to provider offices if requested -Provide patient lists to provider offices -Accurately enter data into Electronic Medical Record Review abstraction tool

    -Communicate daily with Mercy Care support staff to review any changes in daily expectations

    -Perform outreach calls as needed to provider offices to obtain medical records

    Knowledge of MRR process is strongly preferred, especially HEDIS specific audit experience -Experience with a variety of EMR systems strongly preferred -Experience working from home and setting up home office -Experience reading and interpreting medical records, including handwritten records ; Qualification Must Have CVS Caremark Requirements
    Prior CVS/Aetna work experience?
    No
    Verifyable High School Diploma or GED Required
    Yes Is this request for Peak Season? Select applicable value

    Aetna HEDIS

    Duties

    Train staff on assigned Hybrid measure;
    Over-read all chases for assigned measure, both compliant and non-compliant entries;
    Review, abstract and data enter medical record data obtained via paper, electronic, CD, fax or mail;
    Name and file medical record documents electronically, maintaining member PHI and PII;
    Fax medical record requests to provider offices if requested;
    Provide patient lists to provider offices;
    Accurately enter data into Electronic Medical Record Review abstraction tool;
    Communicate daily with abstraction review nurses regarding errors or changes in daily expectations;
    Perform outreach calls as needed to provider offices to obtain medical records

    Experience

    Candidates must have 3 years of HEDIS record abstraction experience, proven organizational and time management skills, experience in a work-from-home scenario, and excellent verbal communication skills clear, concise, and professional.

    Position Summary

    HEDIS Reviewer III will serve as a SME for the HEDIS MY2023 Audit. The nurse SME will attend training provided by Mercy Care/Aetna on required data needed to meet compliance for specific Hybrid HEDIS measures. Responsibilities will include providing training to nurse reviewers on measure abstraction; Over-reading 100% of data entered compliant chases for accuracy; managing all aspects of assigned measure. Candidates must have 3 years of HEDIS record abstraction experience, proven organizational and time management skills, experience in a work-from-home scenario, and excellent verbal communication skills clear, concise, and professional. Position requires flexibility and the ability to work under pressure to meet hard deadlines. Ideal candidate will have experience in training. Qualified candidates will possess a professional demeanor and have a strong work ethic, be self-motivated, a conscientious problem solver, willing to learn, and take personal pride in their work performance/accuracy. Must be computer savvy with working knowledge of Microsoft Excel, Outlook, and Adobe preferred. Candidate must be able to commit to duration of the project.

    Education

    BSN preferred
    RN active and in good standing License required

    What days & hours will the person work in this position? List training hours, if different.

    Mon-Fri; 8-4:30

    Type of Start

    Individual starts

    Program Office – Point Of Contact

    Jennifer Sortor

    Is this an in-person, patient-facing role?

    No

    Onsite Requirements

    Fully remote (never coming onsite)

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