Prominent Managed Care Organization is seeking a HEDIS
Specialist I to work in Troy, MI.
This is a six (6) month contract position with the possibility of
extension/temp to hire.
Max pay is $35.85.
Hours are M-F, 8AM - 5PM. Must be able to work some OT on
occasional Saturdays with advance notice.
This position also requires 25% traveling so all representatives
must have reliable transportation. Fuel will be reimbursed,
Under the direction of the HEDIS Program Manager, supports the
annual HEDIS project management by coordinating the identification,
collection and abstraction of medical records and other data in
collaboration with other HEDIS staff.
Assists the Manager in the coordination and preparation of the
HEDIS medical record review which includes ongoing review of
records submitted by providers and the annual HEDIS medical record
Participates in meetings with vendors for the medical record
collection process. Assists Manager with medical record vendor
Assists Manager in training abstractor staff and participates in
the medical record IRR.
Identifies member service gaps based on data loaded in the HEDIS
Collects medical records and reports from provider offices based on
member needed services reports and gaps and loads data into the
Works with the corporate HEDIS team to monitor accuracy of
abstracted records as required by HEDIS specifications.
Participates in scheduled meetings with the corporate HEDIS team,
vendors and HEDIS auditors.
Assists the QI staff with physician and member interventions and
incentive efforts as needed.
Provides data collection and report development support for Quality
Improvement studies and performance improvement projects.
Assists as needed in support of accreditation activities such as
NCQA reviews, CAHPS and state audits.
Licensed LVN/LPN, Registered Health Information Technician (RHIT),
or Certified Medical Record Technician
0-2 years coding and medical record abstraction experience. 0-2
years managed care experience.
Basic knowledge of HEDIS and NCQA
Proficient with PC-based systems and the ability to learn new
information systems and software programs
Ability to work with large files and data sets
Basic understanding of Health Plan billing practices and
Strong communication and teaming/interpersonal skills; strong
Excellent verbal and written communication skills We are an equal
employment opportunity employer and will consider all qualified
candidates without regard to disability or protected veteran