United States onlyCandidate will work with the HEDIS team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific data base. If necessary the medical record review is conducted on site in provider office or hospital institution. Local travel may be required. This candidate will be required to handle a high volume of telephonic interaction with provider offices. Candidates must follow up on requested medical records with providers. Must keep excellent documentation of research and contact information. Candidate must pass a medical record abstraction test prior to starting actual record reviews
Requires a licensed nurse; RN, LPN, LVN, Licensed professional graduate of an accredited school of nursing. Candidates must have computer skills and analysis capabilities in order to navigate CPT4 code and ICD9 and ICD10 DX based on HEDIS Technical Specification requirements. Candidates must have an understanding of codes for services based on diagnosis and procedure. They must be research and detail oriented with the tenacity to find claim specific data for a specific measure within a given period of time. Knowledge of Microsoft office is required. Requires effective written, oral, and interpersonal communication skills. It is preferred that candidates have basic Excel skills and the ability to type 30-40 WPM. Prior HEDIS experience a plus.
This is a work at home position, can be anywhere in eastern time zone, need high speed internet and at home workspace, they will provide the desktop PC and related equipment,
Hours are Monday- Friday 8 am- 4:30 pm EST
HEDIS experience preferred, excellent computer skills.
One of the largest health insurance company in the country.
