Medical Records Specialist - Charter Global : Job Details

Title: Medical Review - Quality Specialist (HEDIS)

Duration: 12 Months+

Location: Baltimore, MD (Hybrid)

W2 Rate: $32/hr.

This is a hybrid role. The resource may occasionally be required to visit provider offices.

Skills: HEDIS, Medical Terminology, Medical Record Retrieval and Abstraction

PURPOSE:

The Quality Specialist – HEDIS (RN/LPN with clinical experience) will report to the Clinical Support Supervisor – HEDIS and be part of the Quality Team. Their main duties include chart retrieval and conducting thorough medical record reviews using proprietary tools and software. The role requires extensive knowledge of HEDIS measures to accurately and promptly abstract medical records for gap closure and other data collection, all while adhering to HIPAA Privacy and Security standards. Responsibilities also include retrieval follow-up and escalating issues as needed. Expertise in HEDIS and Quality Measures is used to meet productivity and quality targets, enhance measure compliance, and improve rate submissions according to NCQA guidelines and technical specifications.

ESSENTIAL FUNCTIONS:

• 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.

Qualifications

Education Level: Bachelor's degree in Nursing, Associates Degree in Nursing, Diploma in Nursing

Experience: 2-3 years of recent HEDIS abstractions / overreads experience in the payer/health insurance side of HEDIS or with a HEDIS vendor (ex. Cotiviti, Inovalon, Reveleer).

Preferred Qualifications:

At least two consecutive HEDIS seasons with the same company. 2 years clinical experience and good understanding of medical terminology.