HEDIS Over Reader Nurse - Remote - Contract

HireOps Staffing, LLC; Austin (TX); Remote; USD 60,000 - 80,000; Full time

Job summary

An innovative staffing firm is seeking a skilled RN or LPN to join a dynamic team for a contract assignment focused on HEDIS reviews. This role involves conducting thorough medical record reviews, ensuring compliance with NCQA guidelines, and utilizing various software applications to support operations. The ideal candidate will possess strong communication skills, a nursing background, and proficiency in data entry. This is an exciting opportunity to contribute to essential healthcare projects while working remotely in Texas. Join a team dedicated to improving healthcare quality and making a meaningful impact in the field.

Qualifications

• RN or LPN with clinical experience required.
• Must be licensed in the State of Texas.

Responsibilities

• Over-read medical record abstractions accurately and efficiently.
• Identify and report abstraction errors and provide re-education.

Skills

Clear and concise written communication

Clear and concise verbal communication

Knowledge of medical terminology

Data entry and/or typing

Auditing experience

Education

Degree, Diploma, or Certificate from a school of nursing

Tools

Microsoft Word

Microsoft Excel

Lotus Notes

HEDIS Software Application

Job description

This is a contract assignment that will start right away and end on June 28th, 2024.

Location: Remote in TX. Must live in TX.

SUMMARY DESCRIPTION:
RN or LPN with clinical experience will work under the supervision of the HEDIS Coordinator. They are a member of the medical record review team responsible for obtaining and performing accurate comprehensive reviews of medical records in support of The HEDIS Effectiveness Data and Information Set project. HEDIS reviews are completed in accordance with NCQA guidelines and technical specifications.

JOB REQUIREMENTS:

1. Degree, Diploma, or Certificate from a school of nursing with clinical experience.
2. Licensed in the State of Illinois.
3. Knowledge of medical terminology.
4. Data entry and/or typing experience.
5. Clear and concise written and verbal communication skills.
6. PC proficiency to include Word, Excel, and Lotus Notes.
7. Auditing experience preferred.

DUTIES AND RESPONSIBILITIES:

1. Accurately and efficiently over-read medical record abstractions performed by the HEDIS abstraction staff on a daily basis according to HEDIS specifications and company training guidelines.
2. Complete the IRR/over-read tool in the Software Application, including comments if errors are found. Correct errors identified through the over-read process, including a re-review of charts that may contain similar errors.
3. Identify and report abstraction errors and provide measure re-education for the abstractor.
4. Utilize various software applications to support HEDIS operations by entering data and/or changing chase status for the identified chase(s).
5. Meet with HEDIS Coordinator and/or QI Specialists to discuss HEDIS efforts, any open issues, and can include IRR results.
6. Maintain productivity level as determined by the HEDIS Coordinator/QI Department.
7. Maintain compliance with all HIPAA and patient confidentiality requirements.
8. All other duties as assigned.