HEDIS Reviewer

VIVA USA Inc; United States; On-site; USD 42,000 - 66,000; Full time

Job summary

VIVA USA Inc. seeks a HEDIS data abstraction specialist to review medical records, abstract clinical information, and support CMS performance measures. This role requires accuracy, strong technical skills, and 100% computer-based work.

Occasional travel to physician offices may be needed. Nursing license is preferred but not required; successful HEDIS experience can substitute licensure. Training will be provided before the assignment starts.

Qualifications

• Proven ability to audit and abstract medical records.
• Ability to interpret medical terminology and apply it to HEDIS CMS metrics.
• Proficient in computer-based data entry and data management systems.

Responsibilities

• Review medical records to abstract clinical information for HEDIS reporting.
• Coordinate with provider offices for appointment scheduling and records submission.
• Enter data into the applicable software system with accuracy and timeliness.
• Identify trends and opportunities for process improvement.
• Maintain confidentiality of PHI and HIPAA compliance.

Skills

Attention to detail

Communication

Data entry

Education

Nursing license preferred

Tools

Microsoft Word

Excel

Adobe Reader

Job description

Remote with future possibility of onsite

HEDIS

This position interprets relevant clinical criteria through review of medical records, annotates via Adobe PDF and populates a data collection tool to support compliance with HEDIS and CMS performance measures. Ensures accurate and complete documentation of required information to meet risk management, regulatory, and accreditation requirements. The candidate must be proficient with databases and with conducting 100% of work activities on the computer.

Position Summary

Participates in the review of medical records to abstract clinical information for HEDIS reporting. May require travel to physician offices; Nursing license preferred but not required. Successful HEDIS review experience may be substituted for licensure

Duties

• Work with provider offices as needed to schedule/confirm appointments, follow up on medical record submission, and provide patient rosters
• Locate and review ALL assigned medical charts, perform abstraction, copy all supporting documentation per specifications and data enter into the applicable software system ALL assigned abstracts.
• Prioritize and accurately complete tasks within established times
• Identifying trends and documentation of areas for improvement
• Maintaining project productivity levels while maintaining accuracy requirements for abstraction and data entry activities
• Handle incoming calls from providers and voicemails
• Rerouting Return Mail
• Additional tasks as assigned
• This position has a small chance of needing to go onsite to a provider's office to collect needed medical records, again only if needed.

Experience

• 1-3 seasons of experience auditing and abstracting medical records required
• Candidate must commit to attend all required training and conference calls assigned for the project.
• Candidate must return all equipment that is supplied to them in good working condition and in a timely manner at the end of the project
• Medical knowledge/terminology is required.
• Ability to read and interpret medical records.
• Professional demeanor and good work ethic.
• Computer savvy: Microsoft Word, Excel, email, and Adobe reader required. Know how to save a file to a folder.
• Excellent verbal and written communication skills - clear, concise and appropriate.
• Conscientious problem solver, willing to learn, and take personal pride in their work performance/accuracy.
• Exceptional attention to detail and excellent analytical, investigation, and problem-solving skills
• Proven organizational and time management skills including the ability to meet required deadlines
• Must keep all information collected in a safe, organized and confidential manner while maintaining confidentiality of PHI, HIPAA Privacy and Security Rules

Notes

• Remote with future possibility of onsite
• Mon-Fri, 8 hours worked, between 8am-5pm local time
• Training will be provided prior to the start of the assignment.

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status