HEDIS Abstractor - Nurse

Maxim Healthcare Services, Inc.; Cincinnati (OH); Remote; USD 40,000 - 60,000; Full time

Job summary

A leading health insurance company seeks a licensed nurse to join their HEDIS team. This remote position involves collecting and reviewing medical records, requiring strong computer skills and knowledge in coding. Candidates must navigate specific guidelines and demonstrate excellent documentation practices.

Benefits

Home workstation provided

High-speed internet required

Qualifications

• Candidates must have computer skills and analysis capabilities.
• Must understand CPT4 and ICD9/ICD10 coding based on HEDIS specifications.
• Prior HEDIS experience is preferred.

Responsibilities

• Collect member records and conduct reviews by contacting providers.
• Handle high volume of telephonic interaction with provider offices.
• Keep excellent documentation of research and contact information.

Skills

Research

Detail-oriented

Communication

Computer skills

Analysis capabilities

Education

Licensed nurse (RN, LPN, LVN)

Graduate of an accredited school of nursing

Tools

Microsoft Office

Excel

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.