HEDIS QI Retriever

• Collects data for ambulatory medical record reviews and compliance with provider preventive health and chronic disease outcome improvement interventions.
• Prepares reports and quality improvement studies in an accurate, concise and timely fashion.
• Conducts internal auditing for compliance with regulatory and accreditation standards, and monitors and provides consultation to departments to correct deficiencies.
• Communicates with external data sources as needed to gather data necessary to measure identified outcomes.
• Provides communication such as newsletter articles, member education, outreach interventions and provider education.
• Collects and summarizes performance data and identifies opportunities for provider improvement.
• Participates in site visit preparation and execution by regulatory and accreditation agencies (State agencies, CMS, AAAHC, URAC, NCQA,EQRO).
• Pursues methods to ensure receipt of data required for trending and reporting of various QI work plan metrics. Assists in activities to prioritize clinical and service improvement initiatives.
• Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements.
• Ensures assigned contract/regulatory report content is accurate and that submission adheres to deadline.
• Performs other duties as assigned.

• Can be RN/LPN / Medical Coder / Medical Records Specialist
• 3+ years experience with HEDIS measurements and HEDIS auditing preferred
• Managed Care Experience
• Experience with Customer Service, data collection and data entry
• Bachelor’s Degree or equivalent clinical work experience.
• Experience with MS Excel, Access, Power Point, Outlook
• Ability to multitask, work in a fast-paced environment with changing priorities, implement process improvements, and effectively present information and respond to questions from families, members, and providers.
• Interpersonal/verbal communication skills
• Medical terminology and/or experience with CPT & ICD-9 coding

Hours:

Monday-Friday daytime hours, 40 hours

Compensation:

negotiable depending on relevant experience/ license

Interested in hearing more about this great opportunity? Please click Apply Now!

Courtney Phelps

407-636-7030 ext 232