LPN/RN HEDIS Review Nurse
• Performs provider/practitioner medical record reviews, abstraction and data entry for HEDIS and HEDIS-like measures as part of HEDIS Operations
• Reviews assigned medical records in order to abstract clinical data elements for HEDIS reporting, e.g., results of laboratory tests, verification of hypertension and the most recent blood pressure reading, prenatal and postpartum care services
• Integrates data collected from a variety of electronic and paper sources
• Identifies findings supported by documentation guidelines with high level of accuracy
• Documents abstraction findings in HEDIS database tool
• Maintains HIPAA standards and confidentiality of protected health information; reports critical incidents immediately
• Communicates identification of pursuit leads for additional medical records, if needed, to other members of the team
• Attends conference calls as necessary to provide information relating to clinical reviews and compliance
• Successfully completes HEDIS technical specification training and testing
• Successfully completes HEDIS software training and uses software correctly
• Is responsible for meeting daily abstraction production goal
• Is responsible for meeting and maintaining quality requirement of 95% abstraction accuracy
• Performs other duties as assigned
• Clinical degree highly preferred, including, but not limited to: RN, LVN, LPN
• Current, unrestricted state license in applicable field
• Experience working with HEDIS software (data entry, reporting) at least one year
• Experience in medical record review (vendor or health plan; onsite or fax/mail)
• Experience working in EMR systems
Are you an experienced HEDIS nurse in Cincinnati, OH area looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a company that provides on-going training and development? Are you interested in working for a company that offers benefits for full-time permanent employees, flex schedules and the opportunity to grow with the company? If you answered “yes” to any of these questions – this is the position for you!
Interested in hearing more about this great opportunity? Reach out to Joy Iwag at HealthCare Support Staffing for immediate consideration. Interviews are being held ASAP and immediate offers will be extended. Click APPLY NOW for more information; we look forward to hearing for you!