Overview Base pay range: $41.00/hr - $41.00/hr
Title: Registered Nurse / LPN
Duration: 5 Months+
Location: Baltimore, MD Remote
Hybrid Position is primarily remote but will require a three-four day in-person training at CareFirsts Canton location and travel to local Provider offices for onsite Medical Record retrieval as needed. 5 Years Of HEDIS Experience Required.
Responsibilities 10% Call provider offices to request or validate facility/provider contact information specifically for HEDIS medical record retrieval. Document all outreach efforts.
20% Retrieve medical records via EMR that meet HEDIS requirements and ensure compliance with HIPAA. Upload charts to abstraction platform upon receipt.
40% Use extensive knowledge of HEDIS measures to facilitate accurate and efficient data abstraction from charts within the abstraction platform on a daily basis according to HEDIS specifications and company training guidelines.
20% Use various software applications to support HEDIS operations by creating and researching clinical and retrieval pends.
10% Other duties as assigned (see additional functions below).
Overreading Accurately and efficiently over-read medical record abstractions (as performed by the HEDIS abstraction staff) within the abstraction platform on a daily basis according to HEDIS specifications and company training guidelines.
Correct errors identified through the over-read process, including a re-review of charts that may contain similar errors.
Identify and report abstraction errors and provide measure re-education with the abstractor.
Risk Adjustment Medical Record Retrieval for Risk Adjustment, internal Supplemental Data Audit (PSV) and other Quality and HEDIS related tasks.
Qualifications Registered Nurse or Licensed Practical Nurse with experience in payer/health insurance HEDIS reporting abstraction.
Strong understanding of healthcare (NCQA) quality metrics and data abstraction.
Prior experience in HEDIS abstraction of medical records for gap closure within a health plan setting or with a HEDIS vendor (e.g., Reveleer, Cotiviti, Inovalon) is essential.
Detail-oriented with the ability to work independently while maintaining a high level of accuracy.
Proficient in Microsoft Office (Excel, Word, PowerPoint, etc.), Microsoft Teams and Outlook.
Experience using EMR platforms such as Epic, eClinical Works, Athena, Cerner, Allscripts, and Tebra to retrieve medical records.
Proven HEDIS overreading experience for a health plan or HEDIS vendor is a bonus.
Employment type Full-time
Seniority level Mid-Senior level