HEDIS Abstractor - Nurse

Maxim Staffing Solution; Cincinnati (OH); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Desktop PC and equipment provided

Flexible work-from-home environment

Job summary

A leading health insurance staffing firm is seeking a licensed nurse for a work-from-home position. Responsibilities include collecting and reviewing member records, managing telephonic interactions with providers, and ensuring accurate documentation. Candidates must be detail-oriented, possess strong computer skills, and have a valid nursing license from an accredited school of nursing. HEDIS experience is preferred. Working hours are Monday to Friday, 8 am to 4:30 pm EST, with necessary equipment provided.

Qualifications

• Must pass a medical record abstraction test prior to starting actual record reviews.
• Effective written, oral, and interpersonal communication skills required.
• Prior HEDIS experience is a plus.

Responsibilities

• Collect member records and conduct reviews by contacting providers.
• Document research and contact information accurately.
• Handle a high volume of telephonic interactions with provider offices.

Skills

Licensed nurse (RN, LPN, LVN)

Computer skills

Analytical capabilities

Research detail orientation

Interpersonal communication skills

Microsoft Office knowledge

Basic Excel skills

Education

Licensed professional graduate of an accredited school of nursing

Tools

Desktop PC

Job description

Overview

One of the largest health insurance company in the country.

Responsibilities

• 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.

Qualifications

• 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 ICD10 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.

Additional Information

• 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.