LPN/RN HEDIS Review Nurse

• Performs provider/practitioner medical record reviews, abstraction and data entry for HEDIS and HEDIS-like measures as part of HEDIS Operations

• Reviews assigned medical records in order to abstract clinical data elements for HEDIS reporting, e.g., results of laboratory tests, verification of hypertension and the most recent blood pressure reading, prenatal and postpartum care services

• Integrates data collected from a variety of electronic and paper sources

• Identifies findings supported by documentation guidelines with high level of accuracy

• Documents abstraction findings in HEDIS database tool

• Maintains HIPAA standards and confidentiality of protected health information; reports critical incidents immediately

• Communicates identification of pursuit leads for additional medical records, if needed, to other members of the team

• Attends conference calls as necessary to provide information relating to clinical reviews and compliance

• Successfully completes HEDIS technical specification training and testing

• Successfully completes HEDIS software training and uses software correctly

• Is responsible for meeting daily abstraction production goal

• Is responsible for meeting and maintaining quality requirement of 95% abstraction accuracy

• Performs other duties as assigned