HEDIS Reviewer

HEDIS Reviewer

  Not Disclosed

  Woonsocket, RI (100% Remote)

  7.5 Months

  Not Disclosed

  Not Disclosed

  Pharmaceutical

  $24.94/hour - $29.94/hour

Job Description

Job Duties and Responsibilities:
Outreach to members to complete survey to address Social Determinants of Health (SDoH) barriers and provide helpful resources
Outreach to members and clinical providers to effectively coordinate care, obtain medical records and ensure patients receive preventive and chronic disease management services. The goal of these messages is to remind providers, identify if any screenings have already been performed and, if they have not been completed, to assist in any way possible to complete the screenings.
Search for relevant HEDIS records from databases, review medical records using HEDIS technical specification criteria or internal guidelines, and make annotations via Adobe PDF.
Ensure accurate and complete documentation of required information to meet risk management, regulatory, and accreditation requirements.
Perform duties for additionally adhoc projects such as provider outreach to verify demographics and faxing providers.

Position Summary
Participates in the member and provider outreach, collection, and review of medical records to abstract clinical information for HEDIS quality reporting. Training will be provided prior to the start of the assignment.
The candidate must be proficient with databases and with conducting 100% of work activities on the computer.
Must commit to duration of the project with the understanding that work hours can be varied. Due to proprietary information, must inform employer if they are planning to accept employment with another company.

Duties
Complete 60-75 outreach calls to members per day to address HEDIS gaps and provide resources on Social Determinants of Health
Use multiple platforms and tools to search for relevant member records
Complete assigned research lists, fax lists, and calls lists each day
Work with provider offices as needed to schedule/confirm appointments, follow up on medical record submission, and provide patient rosters
Locate and review ALL assigned medical charts, perform abstraction, copy all supporting documentation per specifications and data enter into the applicable software system ALL assigned abstracts.
Prioritize and accurately complete tasks within established times
Identifying trends and documentation of areas for improvement
Maintaining project productivity levels while maintaining accuracy requirements for abstraction and data entry activities?

Experience

1-3 seasons of outreach calls and medical record review experience required
Call center experience is a plus (ability to make 60-75 calls per day)
Candidate must commit to attend all required training and conference calls assigned for the project.
Candidate must return all equipment that is supplied to them in good working condition and in a timely manner at the end of the project
Medical knowledge/terminology is required.
Ability to read and interpret medical records.
Professional demeanor and good work ethic.
Computer savvy: Microsoft Word, Excel, email, and Adobe reader required. Know how to save a file to a folder.
Excellent verbal and written communication skills – clear, concise and appropriate.
Conscientious problem solver, willing to learn, and take personal pride in their work performance/accuracy.
Exceptional attention to detail and excellent analytical, investigation, and problem-solving skills
Proven organizational and time management skills including the ability to meet required deadlines
Must keep all information collected in a safe, organized and confidential manner while maintaining confidentiality of PHI, HIPAA Privacy and Security Rules



Education
High school diploma or GED


Notes:
Monday-Friday, 8am to 5pm local time, 8 hours of work a day
Fully remote (never coming onsite)
VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.