LPN / Licensed Practical Nurse

Collabera • Baltimore Highlands, Maryland, United States • 4h ago

About the Role:

The Quality Specialist – HEDIS (RN/LPN with clinical experience) will be part of the Quality Team and report to the Clinical Support Supervisor
HEDIS.
The main responsibilities include chart retrieval, conducting thorough medical record reviews using proprietary tools and software, and ensuring compliance with HIPAA Privacy and Security standards.

Responsibilities:

Retrieve medical records via EMR or fax request, ensuring HIPAA compliance
Call provider offices to request or validate facility and provider addresses
Upload records and document all outreach efforts
Conduct Medical Record Abstraction and Research during the Medical Record Review Project
Utilize extensive knowledge of HEDIS measures for gap closure and data gathering
Maintain productivity levels as specified by the QI Department
Ensure compliance with HIPAA and member confidentiality requirements
Perform all other assigned duties

Education Qualification:

Required Skills:

5 years of recent HEDIS abstractions/overreads experience in the payer/health insurance side of HEDIS or with a HEDIS vendor
At least two consecutive HEDIS seasons with the same company
2 years clinical experience and good understanding of medical terminology
Proficiency in communication, customer service, interpersonal skills, and working independently or as part of a team
Current knowledge of clinical practices, medical policies, HEDIS, and Medical Record Review
Strong organizational skills, ability to prioritize responsibilities with attention to detail