What are the responsibilities and job description for the Quality Specialist – HEDIS position at Cynet Systems?
Job Description:
Pay Range: $25hr - $30hr
Essential Functions:
50%
Pay Range: $25hr - $30hr
Essential Functions:
50%
- Retrieve medical records via EMR or fax request, ensuring compliance with all HIPAA and member confidentiality requirements.
- Call provider offices to request or validate facility and provider addresses, and/or collect medical records for the HEDIS project.
- Upload records upon receipt.
- Document all outreach efforts.
- Maintain productivity level as specified by the QI Department.
- Conduct Medical Record Abstraction and Research during the Medical Record Review Project.
- Use various software applications to support HEDIS operations by entering data and/or changing chase status for the identified chase(s).
- Utilize extensive knowledge of HEDIS measures to facilitate medical record abstraction for gap closure and additional data gathering.
- Create and research Pends. Maintain productivity level as specified by the QI Department.
- Ensure compliance with all HIPAA and member confidentiality requirements.
- Perform all other assigned duties.
- Bachelor's degree in Nursing, Associates Degree in Nursing, Diploma in Nursing.
- 5 years of recent HEDIS abstractions / overreads experience in the payer/health insurance side of HEDIS or with a HEDIS vendor (ex. Cotiviti, Inovalon, Reveleer).
- At least two consecutive HEDIS seasons with the same company. 2 years clinical experience and good understanding of medical terminology.
- Ability to effectively communicate and provide positive customer service to every internal and external customer - Proficient.
- Strong interpersonal skills.
- Ability to work independently, as well as a member of a team - Advanced.
- Current knowledge of clinical practices and related medical policies - Proficient.
- Current knowledge of clinical practices related to HEDIS and Medical Record Review - Advanced.
- Strong organizational skills, ability to prioritize responsibilities with attention to detail - Proficient.
- Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and web-based technology - Proficient.
- Must possess excellent verbal and written communication skills - Advanced.
Salary : $25 - $30
