About the job
Job Description:
Job Title: ‘HEDIS Reviewer II’
Estimated Length of Assignment: 06+ Months With Possible Extension (01/02/2025 to 06/27/2025)
(The dates provided are only an estimate and not a guarantee)
Est. Pay Range: $26.00/Hour – $29.00/Hour on W2 (USD)
Work Type: Remote Role (Work from Home, IL)
Schedule – 8am -5pm CST
- Participates in the review of medical records to abstract clinical information for HEDIS reporting.
- May require travel to physician offices; Nursing license preferred but not required.
- Successful HEDIS review experience may be substituted for licensure.
Duties
- Interprets relevant clinical criteria and/or medical policy/benefits for an identified case. Determines when to consult appropriate provider or practitioner and to review case with medical Director for additional action.
- Ensures accurate and complete documentation of required information to meet risk management, regulatory, and accreditation requirements.
- Prepares and reports business information to internal and external constituents. Consults with the constituents on solutions to business issues.
- Identifies trends involving clinical issues and reports/recommends solutions to senior management and others.
- Conducts audits and/or assessments to determine compliance with guidelines. Identifies gaps and May assist in the development/re-evaluation of corrective action plans.
Experience
- 2-4 years audit or related business experience required.
- 2 years Clinical Experience Required Preferred
- Managed Care experience preferred
Position Summary
- Participates in the review of medical records to abstract clinical information for HEDIS reporting.
- May require travel to physician offices; Nursing license preferred but not required.
- Successful HEDIS review experience may be substituted for licensure
Education
- High School Diploma/GED