• Job Description

  Req#: 24-19246
  Job Description:
  
  Pay Range: $25hr - $30hr
  
  Essential Functions:
  
  50%
  • 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.
  • Document all outreach efforts.
  • Maintain productivity level as specified by the QI Department.
  50%
  • 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).
  • Utilize extensive knowledge of HEDIS measures to facilitate medical record abstraction for gap closure and additional data gathering.
  • 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.
  Education Level:
  • Bachelor's degree in Nursing, Associates Degree in Nursing, Diploma in Nursing.
  Experience:
  • 5 years of recent HEDIS abstractions / overreads experience in the payer/health insurance side of HEDIS or with a HEDIS vendor (ex. Cotiviti, Inovalon, Reveleer).
  Preferred Qualifications:
  • At least two consecutive HEDIS seasons with the same company. 2 years clinical experience and good understanding of medical terminology.
  Knowledge, Skills and Abilities:
  • Ability to effectively communicate and provide positive customer service to every internal and external customer - Proficient.
  • Strong interpersonal skills.
  • Ability to work independently, as well as a member of a team - Advanced.
  • Current knowledge of clinical practices and related medical policies - Proficient.
  • Current knowledge of clinical practices related to HEDIS and Medical Record Review - Advanced.
  • Strong organizational skills, ability to prioritize responsibilities with attention to detail - Proficient.
  • Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and web-based technology - Proficient.
  • Must possess excellent verbal and written communication skills - Advanced.

• About the company

  We are a team of technical visionaries who joined forces to form a company that would gather the best and brightest talent in the world. The company uses this talent to help other organizations fulfill their technological dreams and goals and make them a reality. Welcome to Cynet Systems Inc. – a premier staffing and recruiting company – a nationally and locally certified diversity firm.

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