HEDIS Abstractor - Nurse

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

Job summary

A leading health insurance company is seeking a licensed nurse to work with the HEDIS team in Cincinnati, Ohio. Responsibilities include collecting and reviewing member records through telephonic interaction with providers. Candidates must possess strong computer skills and detail orientation, as well as effective communication skills. This remote position requires high-speed internet and is available to those in the Eastern time zone.

Benefits

Desktop PC and related equipment provided

Work from home flexibility

Monday-Friday work hours

Qualifications

• Candidates must have computer skills to navigate CPT4 code and ICD9 and ICD10 DX.
• Must be research and detail-oriented with the tenacity to find claim-specific data.
• Preferred basic Excel skills and ability to type 30-40 WPM.

Responsibilities

• Work with the HEDIS team to collect member records and conduct reviews.
• Handle a high volume of telephonic interactions with provider offices.
• Keep excellent documentation of research and contact information.

Skills

Computer skills and analysis capabilities

Detail-oriented research skills

Effective written communication

Effective oral communication

Interpersonal communication skills

Education

Licensed nurse; RN, LPN, LVN

Graduate of accredited school of nursing

Tools

Microsoft Office

Job description

One of the largest health insurance company in the country.

Job Description

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 data base. If necessary the medical record review is conducted on site in provider office or hospital institution. 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. Must 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. It is preferred that candidates have basic Excel skills and the ability to type 30-40 WPM. 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.