Staff with clinical experience, who will be working 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.

DUTIES AND RESPONSIBILITIES:
Initiates phone calls to providers to follow-up faxed request for medical records.
Generate provider letters for request for medical records.
Initiates Fax Cover Page and Provider letters for medical records request.
Identifies and communicates patterns of missing documentation for the assessment of additional records. This entails phoning and faxing medical offices to obtain further information.
Utilizes various software applications to support HEDIS operations by entering data or changing chase status pertaining for the identified chase(s).
Meets with HEDIS Coordinator and / or QI Specialists to discuss HEDIS efforts, any open issues and can include IRR results.
Routes all exclusions and complex issues to the Quality Improvement Specialists/HEDIS Coordinator.
Maintains compliance with HIPAA and patient confidentiality requirements. All other duties as assigned.

JOB REQUIREMENTS:
High School Diploma or GED
Experience is required. Not considering Green Candidates.
Medical Assistant preferred
Knowledge of medical terminology
Customer service skills
Data entry and/or typing experience
Clear and concise written and verbal communication skills
PC proficiency to include Word, Excel and Lotus Notes