Job Title: HEDIS Review Specialist
Job Description
- 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.
Hard Skills
- Strong clinical knowledge/experience
- Medical terminology
- Medical record review
- EMR auditing
- Medical abstractions
- Data entry
Soft Skills
- Effective communication
- Attention to detail
- Confidentiality
Job Type
This is a contract position with a duration of 5 Month(s).
Work Site
This is a fully remote position.
Work Environment
Will be working remote. May be asked to return to the office based on CDC/Safety guidelines, but the team is looking to stay remote for the foreseeable future.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
- Hiring diverse talent
- Maintaining an inclusive environment through persistent self-reflection
- Building a culture of care, engagement, and recognition with clear outcomes
- Ensuring growth opportunities for our people
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
