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Position:HEDIS Medical Record Review Nurse-1
The HEDIS Medical Record Review Nurse will work with the Quality Improvement team to collect member records and conduct a review of the records for the health plan's HEDIS project. The nurse will contact providers to schedule reviews and enter the results of any review into a specific database. Medical record reviews are conducted on site in provider offices, hospitals or other healthcare entities. Local travel may be required. The candidate will be required to handle telephonic interaction with provider offices related to the reviews. The nurse must keep excellent documentation of research and contact information. The nurse must participate in training and must pass a medical record review abstraction test prior to starting actual record reviews. The nurse will be required to maintain consistent reliability rating of 95% or greater.
Role and Responsibilities:
Contact provider offices to establish appointment time to complete medical record reviews.
Complete comprehensive and thorough medical record review to extract medical record data per NCQA specifications for the health plan's HEDIS project.
Enter record review results into NCQA certified software.
Conduct investigation to identify potential locations for medical records.
Maintain confidentiality of Protected Health Information according to HIPAA guidelines and Essence Healthcare policy.
Experience, Qualifications and Education:
Associates Degree in a healthcare related field; Bachelor's Degree preferred
3+ years of experience in acute healthcare setting
3+ years of experience with HEDIS Medical Record Review
Unrestricted Missouri/Illinois licensure as a Registered Nurse or LPN
Proficiency in MS Office applications
Knowledge of CPT codes, ICD-9 Diagnosis codes and HEDIS Technical Specification Requirements related to the HEDIS measures for data extraction.
Effective written, oral and interpersonal communications skills.
Ability to work independently and meet deadlines.
In addition to competitive salaries, challenging work assignments, and developmental opportunities, Lumeris offers employees a comprehensive benefits package to include medical, dental, vision, life insurance, short-term and long-term disability, paid time off (PTO), matching 401K, and tuition assistance.
For more information on Lumeris careers and to apply for positions, please check out our web site: www.lumeris.com/careers
Lumeris is an EEO/AA employer M/F/V/D.
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Location:St. Louis, MO
Time Type:Full time
Status:1 - FT