A-Line Staffing Solutions is looking to hire a HEDIS Reviewer II with a major healthcare company. FULLY REMOTE WORK FROM HOME ( Anywhere in CA )
Compensation:
- $33.00 per hour
- Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
- 401k after 1 year of employment: With employer match and profit sharing
Overview:
- Participates in the review of medical records to abstract clinical information for HEDIS reporting.
- Medical record review and abstraction from electronic medical records and/or faxed/mailed medical records utilizing NCQA HEDIS Technical specifications to optimize Plan HEDIS scores.
- Perform complete and accurate data entry of qualifying services and results into HEDIS electronic database software and other duties as assigned
- May pull records from EMR and make outbound calls in support of provider validation and clean up process.
Responsibilities:
- Interprets relevant clinical criteria and/or medical policy/benefits for an identified case
- Determines when to consult appropriate provider or practitioner and to review case with medical Director for additional action
Ensures accurate and complete documentation of required information to meet risk management, regulatory, and accreditation requirements - Prepares and reports business information to internal and external constituents. Consults with the constituents on solutions to business issues
- Identifies trends involving clinical issues and reports/recommends solutions to senior management and others
- Conducts audits and/or assessments to determine compliance with guidelines
- Identifies gaps and May assist in the development/re-evaluation of corrective action plans
Job Requirements:
Job Requirements:
- 1-4 years audit or related business experience
- Nursing license preferred but not required.
- 2 years Clinical Experience Required Preferred
- Managed Care experience preferred