Job Description:

Perform medical record reviews to support improvement and compliance, abstract HEDIS data, to include over-read of reviews, working collaboratively with internal HEDIS STARs Team and the Quality Team.

Perform administrative functions to include; medical record request, faxing and calls to members and providers as needed. Maintain organized, updated reporting of activities with clear documentation. Required to track, monitor and report on the status of records and volume of work.

Complete claim research to identify the service performed, dates of service, provider type, and place of service. Research may include multiple systems and reports.



 

Active Nursing License with two (2) years of related work experience

Must have previous medical record / quality review experience; HEDIS/STARS preferred

Must be proficient in Microsoft Office (Word, Excel, Outlook, and PowerPoint) as well as Internet research skills

Ability to communicate clearly verbally and in writing

Organizational skills are very important; must be able to work independently to complete tasks with minimal direction.

Preferred:

Disease management experience is helpful

Recent experience in medical record reviews, data collection for HEDIS / Stars