HEDIS Abstractor - Nurse

Overview

One of the largest health insurance company in the country.

• Work with the HEDIS team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific data base.
• If necessary the medical record review is conducted on site in provider office or hospital institution.
• Local travel may be required.
• Handle a high volume of telephonic interaction with provider offices.
• Follow up on requested medical records with providers.
• Keep excellent documentation of research and contact information.
• Candidate must pass a medical record abstraction test prior to starting actual record reviews.

• Requires a licensed nurse; RN, LPN, LVN, Licensed professional graduate of an accredited school of nursing.
• Candidates must have computer skills and analysis capabilities in order to navigate CPT4 code and ICD9 and ICD
  10 DX based on HEDIS Technical Specification requirements.
• Candidates must have an understanding of codes for services based on diagnosis and procedure.
• They must be research and detail oriented with the tenacity to find claim specific data for a specific measure within a given period of time.
• Knowledge of Microsoft office is required.
• Requires effective written, oral, and interpersonal communication skills.
• Basic Excel skills and the ability to type 30-40 WPM is preferred.
• Prior HEDIS experience a plus.

• This is a work at home position, can be anywhere in eastern time zone, need high speed internet and at home workspace, they will provide the desktop PC and related equipment.
• Hours are Monday
  - Friday 8 am- 4:30 pm EST.
• HEDIS experience preferred, excellent computer skills.