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LPN/LVN or RN Quality Review and Audit Lead Representative
2 months ago
Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply
Our people make all the difference in our success.
Quality Review and Audit Lead Representative - Abstraction
The Quality Review and Audit Lead Representative is responsible for supporting our efforts to excel in meeting our HEDIS/Stars goals. As a member of the HEDIS Abstraction Team, this employee will be expected to become knowledgeable of current HEDIS technical specifications and abstraction requirements. They will drive results through their ability to maintain department accuracy and productivity standards.
The Lead Representative works under the direction of the HEDIS Abstraction Manager. These home-based positions are responsible for working independently to review and abstract pertinent medical record information in accordance with multiple study criteria and in alignment with HEDIS specifications. Analysis of information reviewed during audit and outcomes will be collected to share with Market Representatives to identify opportunities to improve member well-being and metric compliance.
Responsibilities:
- Meet daily, weekly, and monthly audit productivity and accuracy goals.
- Maintain and demonstrate working knowledge of systems and processes.
- Supports departmental initiatives.
- Self-motivated, detail oriented, and ability to work independently.
- Participates in team huddles and team projects.
- Provides clear and concise audit findings.
- Works and delivers on assigned projects/tasks timely.
Qualifications:
- Current RN or LPN/LVN license.
- Three years' experience with HEDIS MRR or HEDIS abstraction/over-read preferred.
- Experience with data entry and audit.
- Experience with electronic medical records.
- Intermediate Level experience working with Microsoft Office Products. (Outlook, Word, Excel, and PowerPoint).
- Exceptional verbal and written communication skills, with the ability to articulate with confidence at all levels within the organization is required.
- Strong ability to learn quickly and thrive through change.
- Strong ability to prioritize, multi-task and be detail oriented.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an hourly rate of USD / hourly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
