HEDIS RN / LPN

HEDIS Operations combines talented individuals from many areas of quality, including HEDIS, CAHPS and Accreditation. Our goal is extraordinary performance that exceeds the expectations of the constituents, customers and members we serve. 

In this position, you will work with the HEDIS Operations staff to assist with the 2016 data collection cycle. 

The purposes of this role include, but are not limited to: 

1. Medical record review and collection 

2. Abstraction and data entry for HEDIS and HEDIS-like measures 

3. Over read of medical records 

The candidate must be technically savvy and must be able to work without distraction. This is a high production environment, and candidates must adhere to measured productivity requirements. 

Responsibilities: 

• 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