HEDIS Reviewer III

Duration: 06 Months.

• Participates in the collection and review of medical records to abstract clinical information for HEDIS quality reporting. Training will be provided prior to the start of the assignment.
• This position interprets relevant clinical criteria through review of medical records, annotates via Adobe PDF and populates a data collection tool to support compliance with HEDIS and CMS performance measures. Ensures accurate and complete documentation of required information to meet risk management, regulatory, and accreditation requirements. The candidate must be proficient with databases and with conducting 100% of work activities on the computer.
• Must commit to duration of the project with the understanding that work hours can be varied. Due to proprietary information, must inform their employer if they are planning to accept employment with another company.

Skills: Must Have:  

• Complete assigned abstraction and data entry each day.
• Work with provider offices as needed to schedule/confirm appointments, follow up on medical record submission, and provide patient rosters.
• Locate and review ALL assigned medical charts, perform abstraction, copy all supporting documentation per specifications and data enter the applicable software system ALL assigned abstracts.
• Prioritize and accurately complete tasks within established times.
• Identifying trends and documentation of areas for improvement.
• Maintaining project productivity levels while maintaining accuracy requirements for abstraction and data entry activities.

Experience:

• 4 or more years of experience auditing and abstracting medical records required.
• Candidates must commit to attending all required training and conference calls assigned for the project.
• Candidates must return all equipment that is supplied to them in good working condition and in a timely manner at the end of the project.
• Medical knowledge/terminology is required.
• Ability to read and interpret medical records.
• Professional demeanor and good work ethic.
• Computer savvy: Microsoft Word, Excel, email, and Adobe reader required. Know how to save a file to a folder.
• Excellent verbal and written communication skills – clear, concise, and appropriate.
• Conscientious problem solver, willing to learn, and take personal pride in their work performance/accuracy.
• Exceptional attention to detail and excellent analytical, investigation, and problem-solving skills
• Proven organizational and time management skills including the ability to meet required deadlines.
• Must keep all information collected in a safe, organized, and confidential manner while maintaining confidentiality of PHI, HIPAA Privacy and Security Rules.

Professional Qualification:    

• High School is a MUST.

Experience Required: 03-04 Years.

Shift: MON-FRI, 8am – 5pm