Title : Medical Assistant / Nurse / Quality Control
Duration : 9 Months
Location : Baltimore, MD (Remote Job)
Start date in Mid-November)
PURPOSE :
The Quality Specialist HEDIS (RN / LPN with clinical experience) will report to the Clinical Support Supervisor HEDIS and be part of the Quality Team.
Their main duties include chart retrieval and conducting thorough medical record reviews using proprietary tools and software.
The role requires extensive knowledge of HEDIS measures to accurately and promptly abstract medical records for gap closure and other data collection, all while adhering to HIPAA Privacy and Security standards.
Responsibilities also include retrieval follow-up and escalating issues as needed. Expertise in HEDIS and Quality Measures is used to meet productivity and quality targets, enhance measure compliance, and improve rate submissions according to NCQA guidelines and technical specifications.
ESSENTIAL FUNCTIONS :
- Retrieve medical records via EMR or fax request, ensuring compliance with all HIPAA and member confidentiality requirements.
- Call provider offices to request or validate facility and provider addresses, and / or collect medical records for the HEDIS project.
- Upload records upon receipt.
- Conduct Medical Record Abstraction and Research during the Medical Record Review Project.
- Use various software applications to support HEDIS operations by entering data and / or changing chase status for the identified chase(s).
- Create and research Pends. Maintain productivity level as specified by the QI Department
- Ensure compliance with all HIPAA and member confidentiality requirements.
- Perform all other assigned duties.
Qualifications
Bachelor's degree in Nursing, Associates Degree in Nursing, Diploma in Nursing
2 years Medical Assistant or Nurse with clinical experience and good understanding of medical terminology.
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