About the job
HEDIS NURSE – HYBRID in Tampa 1 day/week
Job Description:
Summary: The candidate will work with the HEDIS team to collect member records and conduct reviews by contacting providers and placing the results into a specific database. If necessary, the medical record review is conducted on-site in provider offices or hospital institutions. Local travel may be required. This candidate will handle a high volume of telephonic interaction with provider offices, follow up on requested medical records, and keep excellent documentation of research and contact information. The candidate must pass a medical record abstraction test before starting actual record reviews.
Major Duties and Responsibilities:
- Adhere to measured productivity requirements, module testing, and retesting to meet minimum requirements.
- Share department responsibilities as assigned.
- Perform research on internal claims systems.
- Be flexible and willing to develop and share strategies to accomplish goals.
- Work under the supervision of internal staff and designated lead to achieve goals and keep the project moving.
- Conduct data analysis and research within the data systems.
- Read and interpret physician handwriting.
- Maintain professional casual work attire.
- Use critical thinking skills to conduct research and locate specific claim information.
- Utilize all resources provided for deep dive research.
Education and Experience:
- Requires a licensed nurse (RN, LPN, LVN) or a licensed professional graduate of an accredited school of nursing.
- Must have computer skills and analysis capabilities to navigate CPT4 code and ICD9 and ICD10 DX based on HEDIS Technical Specification requirements.
- Must understand codes for services based on diagnosis and procedure.
- Must be research and detail-oriented with the tenacity to find claim-specific data for a specific measure within a given period.
- Knowledge of Microsoft Office is required.
- Requires effective written, oral, and interpersonal communication skills.
- Basic Excel skills and the ability to type 30-40 WPM are preferred.
- Prior HEDIS experience is a plus.
Additional Job Description Details:
- Cotiviti software is a plus.
- Seeking an individual who is flexible, a hard worker, aligns with the company’s goals and ethics, and is a team player.
Work Schedule:
- 8:30 AM – 5:00 PM, Monday to Friday
Other Details:
- This position requires driving (outside of the standard commute to/from work).
- This is not a patient/member-facing role.
- Candidates must have computer skills and analysis capabilities to navigate ICD10 DX based on HEDIS Technical Specification requirements.
- Candidates must understand codes for services based on diagnosis and procedure.
- Candidates must be research and detail-oriented with the tenacity to find claim-specific data for a specific measure within a given period.
- Knowledge of Microsoft Office is required.
- Requires effective written, oral, and interpersonal communication skills.
- Basic Excel skills, the ability to type 30-40 WPM, and Adobe Pro knowledge are preferred.
- Prior HEDIS experience is a plus.
- This position supports FL Health Plan members and requires Level II Fingerprint screening.