Will work under the supervision of the HEDIS Coordinator. They are a member of the medical record review team. The team is responsible for obtaining and performing accurate comprehensive reviews of medical records in support of The HEDIS Effectiveness Data and Information Set project. HEDIS reviews are completed in accordance with NCQA guidelines and technical specifications.

JOB REQUIREMENTS:
7+ Years
experience
Knowledge of medical terminology
Data entry and/or typing experience.
Clear and concise written and verbal communication skills.
PC proficiency to include Word, Excel and Lotus Notes.
Auditing experience helpful

DUTIES AND RESPONSIBILITIES:
Reviews and abstracts medical records according to specifications and BCBSIL training guidelines.
Utilizes various software applications to support HEDIS operations by entering data and / or changing chase status for the identified chase(s).
Makes notations on the electronic record of qualifying HEDIS data.
Performs accurate data entry as well as seeks out patterns of missing documentation for additional records.
Maintains a less than 5% documentation error rate in record abstraction and data entry.
Accepts instruction from the Overreader on abstraction errors with re-education regarding the measure.
Maintains productivity level as determined by the HEDIS Coordinator/QI Department.
Meets with HEDIS Coordinator and / or QI Specialists to discuss HEDIS efforts, any open issues and can include IRR results.
Maintains compliance with all HIPAA and patient confidentiality requirements.
All other duties as assigned.