HEDIS Abstractor – Nurse

Location: Los Angeles, CA
Description: HEDIS Abstractor – Nurse

This job will have the following responsibilities:

• 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. MAJOR DUTIES AND RESPONSIBILITIES: This is a high production environment and candidates must adhere to measured productivity requirements, module testing and at times retesting to meet minimum requirements. Sharing of department responsibilities as assigned. Required to perform research on internal claims systems. 
• Candidates must live within an acceptable commuting distance and reliable transportation is required. Work attire is professional casual. Candidates must have critical thinking skills as they will conduct research in a thoughtful and methodical search in order to locate specific claim information. REDUCATION AND EXPERIENCE: 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.

Qualifications & Requirements:

• 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.

Contact: khawkins@judge.com