Job Title: Medicaid HEDIS Nurse
Job Description
You will work with the HEDIS team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific database. This role requires handling a high volume of telephonic interaction with provider offices, performing research on internal claims systems, and developing strategies to accomplish goals. You will work under the supervision of internal staff and designated leads to achieve project goals.
Responsibilities
- Collect member records and conduct reviews by contacting providers.
- Place collected results into a specific database.
- Handle a high volume of telephonic interaction with provider offices.
- Perform research on internal claims systems.
- Develop and share strategies to accomplish project goals.
- Work under the supervision of internal staff and designated leads.
- Conduct data analysis and research within data systems.
- Read and interpret physician handwriting accurately.
- Use critical thinking skills to locate specific claim information.
- Perform deep dive research using specific platforms (e.g., Immunization registries, local claims systems).
Essential Skills
- LPN, LVN, or RN license.
- Associate's degree in Nursing.
- Experience with Medicaid.
- Two seasons of HEDIS/STARS experience.
- Critical thinking and analysis skills.
- Tenacity for hunting down information from patient charts.
- Typing speed of 30+ WPM.
- Strong knowledge of Microsoft Office and Teams.
Additional Skills & Qualifications
- Prior experience with ICD9, ICD10, or CPT coding.
- Experience with EMR systems (e.g., QSHR, Reveleer, Cotiviti, Rapid, M360, Labcorp, Quest portals, Facets).
- RN, overread, and clinical review experience preferred.
Work Environment
This is a fully-remote/Hybrid position with equipment provided, including dual screens. The work schedule is Monday to Friday, 8am to 5pm EST. The work attire is professional casual. Candidates must live in the state of Florida as local travel and team meetings will be required.
Pay and Benefits
The pay range for this position is $28.00 - $32.00
- Medical, dental & vision
- Critical Illness, Accident, and Hospital
- 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully remote position.
Application Deadline
This position will be accepting applications until Dec 20, 2024.
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.
