A leading, national, managed care provider, is seeking several HEDIS Specialist's for their Troy, MI location. This role supports the HEDIS data collection project by timely accomplishment of the following activities:
Collect, review and extract documentation from medical records as part of the HEDIS data collection project. Research claims history to determine most appropriate and likely source of necessary documentation. Work with providers to secure the medical records. Based on a strong knowledge of HEDIS criteria identify the medical information that supports the specific HEDIS measure. Enter extracted data into Catalyst system. Prepare the medical records for possible audit. This position is responsible for obtaining, organizing and securing a very large volume of medical records within a limited time-frame.
Available for day travel and own transportation required with valid State driver's license.
• Associate's Degree or higher education
• Managed Care and clinical background.
• Medical record auditing experience
• Strong foundation of current, broad-based medical knowledge required
• HEDIS experience
• Quality Management experience; Quality Improvement auditing experience
Licensure & Certification:
• Professional Nurse (RN) with a valid and active Michigan license required.
• Valid MI driver's license
KNOWLEDGE, SKILLS AND ABILITIES:
• Good interpersonal and excellent organizational skills needed to handle a very large volume of records required.
• Basic computer skills and the ability to learn new software required.
• HEDIS Medical Record Review project
• Investigating and resolving Quality of Care Issues
• Adheres to the company/departmental confidentiality and HIPAA compliance programs.
• Adheres to the company/departmental fraud and abuse prevention/detection policies and programs
• Ensuring adherence to NCQA guidelines
This is a 3 month assignment and a great opportunity to get your foot in the door with a national organization.
Immediate need! Please submit updated resume for consideration.