HEDIS Data Reviewer - Hybrid

Title:           HEDIS Data Reviewer - Hybrid

 

 

 

 

 

Mandatory skills:

 

HEDIS data,
chart review, chart collection,
HEDIS, QRS, STARs,
medical terminology, charting, diabetic labs, HPV testing, preventive health screenings, immunization, well-care terminology,
HEDIS Technical Specifications, HEDIS audit process, PSV, CSV, MRRV,
Excel, Word, Power Point, Outlook,
medical record abstraction tool, Medical Record Review Operations, medical records identification process, collection activities, review, medical record review abstraction,
Pediatric, Maternity, Diabetic, Provider Office Setting,
Cancer Registry, Bright Futures,
Quality reporting, Healthcare Effectiveness Data and Information Set, HEDIS        

 

Description:

 

Duties:

Under the direction of the Manager of Medical Record Review Operations, the HEDIS Data Reviewer is responsible for performing medical record abstraction and overread in support of Quality reporting (annual Healthcare Effectiveness Data and Information Set (HEDIS) and State EQRO) with duties including but not limited to the following:
Coordination of the medical records identification process, collection activities and review.
Performing and applying structured auditing abstraction criteria to medical records to determine compliance.
Utilizing various software applications to support department operations and accurately entering the results of chart audits into the database.
Developing and maintaining expertise in the requirements and parameters of mandated HEDIS and State performance measures.
Completing medical record review abstraction and overread and providing feedback for medical records that do not meet the HEDIS or State Measure Technical Specifications criteria within a live software environment.
Providing clinical and administrative support to providers as directed.
Maintaining productivity level of a minimum of chases/charts per defined period according to policy.
Maintaining an abstraction proficiency rate of 98% by correctly reading, interpreting, and abstracting various components of the medical record such as notes, consultations, medication forms, treatment plans, health history, interval history, and past history.
Assisting in the medical record collection process including making phone calls, sending out faxes/letters or chart retrieval requests to providers as assigned.
Completing additional designated projects assigned and deemed as necessary.

Skills:

Three to five years working with HEDIS data including chart review/collection. HEDIS, QRS, or STARs experience. Knowledge of medical terminology and basic charting to include diabetic labs, HPV testing, preventive health screenings, immunization and well-care terminology for children, adults and pregnant women.
Understanding of current HEDIS Technical Specifications.
Knowledgeable in the HEDIS audit process (PSV, CSV and MRRV).
Proficiency in Excel, Word, Power Point and Outlook.
Experience with medical record abstraction tool(s) and wiliness to learn any medical record abstraction tool.
Experience in the Pediatric, Maternity, Diabetic or Provider Office Setting.
Familiar with the Cancer Registry.
Familiar with Bright Futures.
Strong written and oral communication skills, critical thinking skills, strong organizational skills.
Able to think and work independently, effectively, and under pressure of deadlines.

Education:

Associates Degree, RN, LPN, or relevant work experience

Notes:

Hybrid 3 days onsite
Schedule from 8 am -5:30 pm EST, Monday – Friday, some weekend work may be required

 

 

 

VIVA USA is an equal opportunity employer and is committed to maintaining a professional working environment that is free from discrimination and unlawful harassment. The Management, contractors, and staff of VIVA USA shall respect others without regard to race, sex, religion, age, color, creed, national or ethnic origin, physical, mental or sensory disability, marital status, sexual orientation, or status as a Vietnam-era, recently separated veteran, Active war time or campaign badge veteran, Armed forces service medal veteran, or disabled veteran. Please contact us at for any complaints, comments and suggestions.

 

Contact Details :

Account co-ordinator: Amirtha Valli Ravanan, Phone No: (847) 461-3596, Email: staffing10@viva-it.com

VIVA USA INC.
3601 Algonquin Road, Suite 425
Rolling Meadows, IL 60008