Assignment Start Date: Late December 2018 OR Early January 2019 (TBD — this posting will be updated once the start date is determined)
Assignment End Date: Mid May 2019 (tentative)
Assignment Location: REMOTE
Must have a working PC that is less than 5 years old, an internet connection with a speed of at least 50mbps upload capability, 2 monitors, and the ability to received and send messages via smartphone, text, and email.
MAJOR DUTIES AND RESPONSIBILITIES:Candidate will work with the HEDIS ®team to collect member records, conduct medical record abstraction reviews and deep dive research of these records. Reviews require data analysis within data/claims systems, along with critical thinking skills as they will conduct research in a thoughtful and methodical search in order to locate specific claim/provider information. Research includes all resources provided in order to find best information. Examples of deep dive research would be based on specific platforms (i.e. Immunization registries, local claims system membership; NPI registries; Google and defaulted claim information). Candidates must have excellent skill set to read and interpret physician handwriting. Results collected will be placed into specific database(s). Additionally, candidates must be willing to contact providers on an as needed basis to follow up on requested medical records and must keep excellent documentation of research and contact information. Candidates must work under the supervision of internal staff and designated lead in order to achieve goals and keep the project moving by adhering to measured productivity requirements. Module testing for HEDIS® specific measures may be required according to designated role. Candidate must pass a medical record abstraction test prior to starting actual record reviews. Must be flexible and willing to develop and share strategies to accomplish goals. Project is a timed study with tight deadlines that require high production.
REQUIRED EXPERIENCE AND KNOWLEDGE:
- Requires a licensed nurse; RN, LPN, LVN, Licensed professional graduate of an accredited school of nursing or other type healthcare background. Any combination of education and/or experience which would provide an equivalent background will be considered.
- Requires a strong knowledge of HEDIS® technical specifications and NCQA health plan accreditation guidelines (minimum 2 years).
- Excellent skillset for audit and abstraction of medical records
- Demonstrated knowledge and experience in managed care membership, provider, and/or hospital systems preferred.
- Candidates must have excellent computer skills and analysis capabilities, along with ability to log-on into multiple software as service tools and use of two computer (dual) monitors
- Knowledge of Microsoft office is required (proficient in Word, Excel, Outlook)
- Candidates must have an understanding of codes for services based on diagnosis and procedure in order to navigate CPT4 and ICD DX codes based on HEDIS® Technical Specification requirements.
- Must be research and detail oriented with the tenacity to find medical record and claim specific data for a specific measure within a given period of time.
- Requires effective written, oral, and interpersonal communication skills.
- It is preferred that candidates have ability to type 30-40 WPM.
- Experience with Electronic Medical Record systems is a plus
Pay Rate: $26.00 – $30.00 /hour DOE