HEDIS Abstractor - Nurse

Job ID: JP00044003

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for contract workers (via BCforward) who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Candidate 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 data base. If necessary the medical record review is conducted on site in provider office or hospital institution. Local travel may be required. This candidate will be required to handle a high volume of telephonic interaction with provider offices. Candidates must follow up on requested medical records with providers. Must keep excellent documentation of research and contact information. Candidate must pass a medical record abstraction test prior to starting actual record reviews.

Primary duties may include, but are not limited to:

• This is a high production environment and candidates must adhere to measured productivity requirements, module testing and at times retesting to meet minimum requirements.
• Sharing of department responsibilities as assigned.
• Required to perform research on internal claims systems.
• Must be flexible and willing to develop and share strategies to accomplish goals.
• Work under the supervision of Anthem internal staff and designated lead in order to achieve goals and keep the project moving.
• Reviews require data analysis and research within the Anthem data systems.
• Candidates must have excellent skill set to read and interpret physician handwriting.
• Candidates must live within an acceptable commuting distance and reliable transportation is required.
• Work attire is professional casual.
• Candidates must have critical thinking skills as they will conduct research in a thoughtful and methodical search in order to locate specific claim information.
• Research includes all resources provided in order to find best information.
• Examples of deep dive research would be based on Anthem specific platforms (i.e. Immunization registries, local claims system membership and defaulted claim information).

Requirements:

• Requires a licensed nurse; RN, LPN, LVN, Licensed professional graduate of an accredited school of nursing.
• Candidates must have computer skills and analysis capabilities in order to navigate CPT4 code and ICD9 and ICD10 DX based on HEDIS Technical Specification requirements.
• Candidates must have an understanding of codes for services based on diagnosis and procedure.
• They must be research and detail oriented with the tenacity to find claim specific data for a specific measure within a given period of time.
• Knowledge of Microsoft office is required. Requires effective written, oral, and interpersonal communication skills.
• It is preferred that candidates have basic Excel skills and the ability to type 30-40 WPM.
• Prior HEDIS experience a plus.

Additional Details:

• Monday - Friday 8:00AM - 4:30PM (EST)
• Candidate can work from home.

BCForward is An Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

Privacy Notice for California Residents