HEDIS Abstractor - Nurse

Maxim Healthcare Services, Inc.; Cincinnati (OH); Remote; USD 40,000 - 80,000; Full time

Job summary

An established industry player is seeking a detail-oriented licensed nurse to join their HEDIS team. In this dynamic role, you will be responsible for collecting and reviewing medical records, ensuring compliance with HEDIS Technical Specifications. This position requires strong telephonic communication skills and the ability to navigate complex medical coding systems. As a remote opportunity, you can work from the comfort of your home, provided you have a reliable internet connection and a dedicated workspace. If you have a passion for healthcare and possess the tenacity to find claim-specific data, this is the perfect opportunity for you to make a meaningful impact in the health insurance sector.

Benefits

Work from home

Company-provided desktop PC

Flexible hours

Health insurance

Paid time off

Qualifications

• Candidates must be licensed nurses with strong computer and analysis skills.
• Must have knowledge of medical coding and effective communication skills.

Responsibilities

• Work with the HEDIS team to collect and review member records.
• Conduct telephonic interactions and document research findings.

Skills

Telephonic interaction

Medical record abstraction

CPT4 codes knowledge

ICD9 and ICD10 knowledge

Documentation skills

Research skills

Detail-oriented

Effective communication

Microsoft Office

Basic Excel skills

Education

Licensed nurse (RN, LPN, LVN)

Graduate of accredited nursing school

Tools

Desktop PC

High-speed internet

Job description

One of the largest health insurance companies in the country.

Job Description

The candidate will 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 database. If necessary, the medical record review is conducted on-site in provider offices or hospital institutions. Local travel may be required. This candidate will be required to handle a high volume of telephonic interaction with provider offices. Candidates must follow up on requested medical records with providers and keep excellent documentation of research and contact information. The candidate must pass a medical record abstraction test prior to starting actual record reviews.

Qualifications

Requires a licensed nurse: RN, LPN, LVN, or licensed professional graduate of an accredited school of nursing. Candidates must have computer skills and analysis capabilities in order to navigate CPT4 codes 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. Effective written, oral, and interpersonal communication skills are necessary. It is preferred that candidates have basic Excel skills and the ability to type 30-40 WPM. Prior HEDIS experience is a plus.

Additional Information

This is a work-at-home position, can be anywhere in the Eastern Time Zone, need high-speed internet and at-home workspace. The company will provide the desktop PC and related equipment. Hours are Monday to Friday, 8 AM to 4:30 PM EST. HEDIS experience preferred, excellent computer skills are required.