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HEDIS Review Nurse

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Actalent

2mo ago

  • Job
    Full-time
    Mid Level
  • Data
    Healthcare
  • Chicago
    Remote

AI generated summary

  • You must have strong clinical experience, knowledge of medical terminology, skills in record review and EMR auditing, data entry, communication, attention to detail, and uphold confidentiality.
  • You will retrieve and audit medical records, interpret charts, abstract data accurately, and ensure compliance with care standards while collaborating with the Medicare Quality team.

Requirements

  • Strong clinical knowledge/experience
  • Medical terminology
  • Medical record review
  • EMR auditing
  • Medical abstractions
  • Data entry
  • Effective communication
  • Attention to detail
  • Confidentiality

Responsibilities

  • Will be calling out to providers and doctors' offices to retrieve medical information and ask any follow-up questions needed to get information entered.
  • Need to have strong clinical knowledge/experience in order to interpret medical records/charts to find the necessary information.
  • Will be auditing EMRs.
  • Will be part of the Quality Department for the Medicare Team, working alongside full-time members with audits and provider clean-up.
  • Will be part of the HEDIS team during the Jan-May season.
  • Review medical records from all 5 states.
  • Abstracting 6 medical records per hour.
  • Data abstraction at 95% accuracy - must understand the abstraction data entries.
  • If they don’t meet the abstraction rate, they will be retrained.
  • Candidate must know the measures.
  • Medical reconciliation - need to be done on critical cases.
  • A RN or LPN/LVN responsible for annual patient chart inspection/audit.
  • Audits are conducted to ensure that providers (MDs) accepting insurance are in compliance with standards of patient care set forth by the insurance company.
  • Experience with medical record review required.

FAQs

What is the job title for this position?

The job title for this position is HEDIS Review Nurse.

What are the primary responsibilities of the HEDIS Review Nurse?

The primary responsibilities include calling providers and doctors' offices to retrieve medical information, auditing EMRs, reviewing medical records for HEDIS measures, and conducting data abstraction.

What is the expected accuracy rate for data abstraction in this role?

The expected accuracy rate for data abstraction is 95%.

What qualifications are required for this position?

A strong clinical knowledge or experience, medical record review experience, and familiarity with medical terminology are required. A valid RN or LPN/LVN license is preferred.

What types of skills are necessary for success in this role?

Key hard skills include medical record review, EMR auditing, and data entry, while soft skills encompass effective communication, attention to detail, and maintaining confidentiality.

Is this a full-time position?

No, this is a contract position with a duration of 5 months.

How many medical records does the HEDIS Review Nurse need to abstract per hour?

The HEDIS Review Nurse is expected to abstract 6 medical records per hour.

Where is the worksite for this position?

This is a fully remote position, although team members may be asked to return to the office based on CDC/Safety guidelines.

What department will the HEDIS Review Nurse be part of?

The HEDIS Review Nurse will be part of the Quality Department for the Medicare Team.

What is Actalent's commitment to diversity and inclusion?

Actalent is committed to diversity and inclusion by hiring diverse talent, maintaining an inclusive environment, building a culture of care and recognition, and ensuring growth opportunities for all employees.

What should candidates do if they need accommodations during the application process?

Candidates can request reasonable accommodations by emailing actalentaccommodation@actalentservices.com for adjustment options.

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