Healthcare Insurance Co. ANNOUNCES PROJECT OPENING

TITLE: HEDIS QA COMPLIANCE REVIEW CONTRACTOR

Department: Quality Management

Supervisor: Lead Trainer/HEDIS Retriever

Compensation: $32.00 - 40.00 PER HOUR

Apply - Qualified candidates, please email your resume to cjason@networkesc.com for consideration

Purpose of Position:

The primary function of the HEDIS Retriever - Immediate contractor is to conduct onsite abstraction of services from medical charts in compliance with HEDIS/QARR, Medicare Advantage Star measure specifications. This position will be an integral part of the annual Medical Record Review project required to report HEDIS and QARR measures to the NYS Department of Health and Centers for Medicare & Medicaid Services (CMS). The role is field-based and seasonal (November of the measurement year through May of the reporting year), approximately seven months.

The position requires the ability to travel within the five boroughs daily.

Scope of Role & Responsibilities:

Maintain knowledge of medical record review and EMR systems.

Maintain up-to-date knowledge of HEDIS, QARR and Star specifications

Proficiency in MS Office applications, scanning and accurate data entry into MetroPlus systems

Distribute requests for records and schedules appointments with provider offices to ensure timely completion of duties to meet internal and regulatory standards and requirements.

Perform abstraction via EMR, in-house paper medical records, on-site provider visits to collect documentation of measure compliance.
Data enter accurate and timely findings in the appropriate system(s) in accordance with established documentation standards for Healthcare Plan to ensure integrity of member services provided over the continuum of care and over time.

Required Education, Training & Professional Experience:

High School/GED with a minimum of two years HEDIS review experience. Clinical background preferred (Medical Assistant, Nursing Assistant, Health Educator, LPN, RN, LMSW or LCSW).
Experience with medical record review working on HEDIS/QARR in a managed care, health plan or provider office setting.
Proficient in Microsoft Office applications including Word, Excel, PowerPoint and Access.

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HEDIS QA COMPLIANCE REVIEW CONTRACTOR