HEDIS Abstractor - Nurse

Job ID: JP00045360

Anticipated Start Date: 03/01/2025

Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

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.
• Cotiviti software is a plus.
• Besides what is described in the job description, and required skill sets, we are seeking an individual who is flexible, hard worker and aligns with the goals and ethics of the company and is a team player.

Job Type: Contract opportunity.

Additional Details:

• This position will support FL Health Plan members.
• Will require Level II Fingerprint screening.
• Work location: 5411 Sky Center Drive, Tampa, FL USA 33607.
• 8:30 AM - 5:00 PM M-F.
• Tampa: Hybrid - in-office 1 day/week.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

About BCforward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

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 based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.