Clinical Medical Review Nurse from ALTA IT Services
Baltimore, MD 21224
About the Job
ALTA IT Services is staffing a contract opportunity for a Clinical HEDIS Specialist support a leading health insurance customer. The main duties include conducting thorough HEDIS overreads in line with NCQA guidelines. Additional tasks involve helping with Medical Record Retrieval for HEDIS and Risk Adjustment, participating in internal audits for Supplemental Data, and supporting other needs within the Quality Department.
Pay: $37/HR
90% Remote
May need to go onsite in Baltimore, MD
Must have LPN or RN
Responsibilities:
Pay: $37/HR
90% Remote
May need to go onsite in Baltimore, MD
Must have LPN or RN
Responsibilities:
- Accurately and efficiently over-read medical record abstractions performed by the HEDIS abstraction staff on a daily basis according to HEDIS specifications and company training guidelines.
- Complete the over-read process in the Software Application, including comments if errors are found. Correct errors identified through over-read process, including a re-review of charts that may contain similar errors.
- Identify and report abstraction errors and provide measure re-education with the abstractor.
- Utilizes various software applications to support HEDIS operations by entering data and / or changing chase status for the identified chase(s).
- Maintains productivity level as determined by the QI Department.
- Maintain compliance with all HIPPA and member confidentiality requirements.
- Medical Record Retrieval, Abstraction and Research during the Medical Record Review Project
- Medical Record Retrieval for Risk Adjustment, internal Supplemental Data Audit (PSV) and other Quality and HEDIS related tasks in the off-season
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