Clinical Quality Analyst - PRIDE Health : Job Details

Pride Health is hiring Clinical Quality Analysts for our top Healthcare Insurance company! This team helps assist with the HEDIS data collection cycle

Pay: $37-$40 per hour

Shift: M-F 8 am-5 pm

Contract: December or January-May

Duties:

• Overread medical records for HEDIS measures
• Research claims systems for alternate chase opportunities/make outbound calls to providers
• Attend team meetings to provide information relating to clinical reviews
• Maintain HIPAA standards and confidentiality of protected health information
• Other duties as assigned

Requirements:

• One plus year HEDIS / medical record review
• One plus year of healthcare/ health plan industry experience
• Experience with abstraction/overread
• Experience with the following measures: BPD, CBP, CCS, COL, COA, HBD, EED, CIS, DVSCH, IMA, LSC, PPC, TRC, and WCC. Experience with LTSS, FFR, and FFS is a plus.
• RN, LPN, preferred but not required.
• Strong critical thinking skills
• Proficient in Microsoft Office (Word, Excel, Adobe, PowerPoint)

Additional Information:

• Fully remote position, M-F 8 am-5 pm in your time zone
• Ability to commit December-May
• Must complete HEDIS-specific training and testing with a passing score of 95% or higher

Pride Global offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto home insurance, pet insurance, and employee discounts with preferred vendors.