About the job
Title: Registered Nurse / LPN
Duration: 5 Months+
Location: Baltimore, MD – Remote
Hybrid – Position is primarily remote but will be required to attend a three-four day in-person training at CareFirst’s Canton location as well as travel to local Provider offices for onsite Medical Record retrieval as needed.
5Years Of HEDIS Experience Required
We are seeking a qualified RN/LPN with experience in the payer/health insurance side of HEDIS reporting abstraction processes. The ideal candidate will have a robust understanding of healthcare (NCQA) quality metrics and a proven track record of accurate data abstraction and interpretation. Prior experience in HEDIS abstraction of medical records for gap closure within the health plan setting or prior experience with a HEDIS vendor (ex. Reveleer, Cotiviti, Inovalon) is essential for this role. Applicants must be detail-oriented and able to work independently while maintaining a high level of accuracy. Proficient skills and experience using Microsoft Office (Excel, Word, Power Point, etc.), Microsoft Teams and Outlook are required. Experience utilizing various EMR platforms including Epic, eClinical Works, Athena, Cerner, All Scripts, and Tebra to retrieve medical records is essential for this role.
Proven HEDIS overreading experience for a health plan or HEDIS vendor is a bonus.
Essential Functions
10% Call provider offices to request or validate facility/provider contact information specifically for HEDIS medical record retrieval. Document all outreach efforts.
20% Retrieve medical records via EMR that meet HEDIS requirements and ensure compliance with HIPAA. Upload charts to abstraction platform upon receipt.
40% Use extensive knowledge of HEDIS measures to facilitate accurate and efficient data abstraction from charts within the abstraction platform on a daily basis according to HEDIS specifications and company training guidelines.
20% Use various software applications to support HEDIS operations by creating and researching clinical and retrieval pends
10% Other duties as assigned (see ‘additional functions’ below)
Overreading (may Replace The Abstraction Function)
- Accurately and efficiently over-read medical record abstractions (as performed by the HEDIS abstraction staff) within the abstraction platform on a daily basis according to HEDIS specifications and company training guidelines.
- Correct errors identified through the 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.
Risk Adjustment
- Medical Record Retrieval for Risk Adjustment, internal Supplemental Data Audit (PSV) and other Quality and HEDIS related tasks in the off-season