HEDIS Retriever/Quality Reviewer (Hybrid) - Network ESC

Purpose of Position:

The primary function of the HEDIS Retriever - Seasonal is to conduct onsite abstraction of services from medical charts in compliance with HEDIS/QARR, Medicare Advantage Star measure specifications. This position will be an integral part of the annual Medical Record Review project required to report HEDIS and QARR measures to the NYS Department of Health and Centers for Medicare & Medicaid Services (CMS). 

 The position requires the ability to travel within the five boroughs daily.

Scope Of Role and Responsibilities:

• Maintain knoowledge of medical record review and EMR systems
• Maintain up to date knowledge of HEDIS, QARR and STAR specifications.
• Proficiency in MS Office applications, scanning and accurate Data entry into our systems
• Distibute requests for records and schedules appointments with provideroffices to ensure timely completion of duties to meet internaland regulatory standards and requirements.
• Perform abstractions via EMR, in house paper medical records, on- site provider visits to collectdocumentationof easure complaince.
• Data enter accurate and timely findings in the approproate systems in accordance with established documentation standards for our health plan to ensure integrity of memberservices provided overthe continuum of care and over time. 

Required Education, Training, and Professional Experience:

• High School/GED with a minimum of two yeards HEDIS review experience. Clinical background preferred ( Medical Assistant, Nursing Assistant, Health Educator, LPN, RN, LMSW, or LCSW)
• Experience with medical record working on HEDIS/QARR in a managed care, health plan and provider office setting.
• Proficient in Microsoft Office applications including Work, Excel, PowerPoint and Access. 

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