HEDIS Reviewer

Louisville, KY | 6 months contract

Post Date: 11/13/2017 Job ID: WCG1JP00004308 Industry: Healthcare


Key Duties and Responsibilities 
Collects data for ambulatory medical record reviews and compliance with provider preventive health and chronic disease outcome improvement interventions. 
Prepares reports and quality improvement studies in an accurate, concise and timely fashion. 
Conducts internal auditing for compliance with regulatory and accreditation standards, and monitors and provides consultation to departments to correct deficiencies. 
Communicates with external data sources as needed to gather data necessary to measure identified outcomes. 
Provides communication such as newsletter articles, member education, outreach interventions and provider education. 
Collects and summarizes performance data and identifies opportunities for provider improvement. 
Participates in site visit preparation and execution by regulatory and accreditation agencies (State agencies, CMS, AAAHC, URAC, NCQA,EQRO). 
Pursues methods to ensure receipt of data required for trending and reporting of various QI work plan metrics. Assists in activities to prioritize clinical and service improvement initiatives. 
Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements. 
Ensures assigned contract/regulatory report content is accurate and that submission adheres to deadline. 
Performs other duties as assigned. 

Education Level 
A Bachelor's Degree in a related field or equivalent work experience 

Experience Level 
3+ years of experience in HEDIS and/or quality improvement -Required 
Experience in a managed care health services environment- Required 
Experience in data collection and data entry- Required 

Skill Sets 
Knowledge of medical terminology and/or experience with CPT and ICD-9 coding 
Demonstrated interpersonal/verbal communication skills 
Ability to multi-task 
Ability to work in a fast paced environment with changing priorities 
Ability to implement process improvements 
Ability to effectively present information and respond to questions from families, members, and providers 

Microsoft Excel 
Microsoft Access 
Microsoft PowerPoint 
Microsoft Outlook 

**HEDIS Reviewers - Can be RN / LPN / Medical Coder / Medical Records Specialist**


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