Quality Reviewer

3 weeks ago

San Antonio, United States CSI Companies Full time

Title of Job: HEDIS Quality Specialist


Location: Remote in San Antonio, TX


CSI Companies is hiring a HEDIS Quality Specialist for our Fortune 100 healthcare client in San Antonio, TX (near the intersection of Dominion Dr and Frontage Rd).


Job Summary

The HEDIS Quality Specialist will play a crucial role in medical record review, data abstraction, and quality monitoring while adhering to high productivity and accuracy standards.


Pay: $26 – 33 an hour based on experience (overtime will be paid at 1.5 times the normal hourly pay rate)


Hours: Full Time - Monday-Friday 8am-5pm CST


Status: Long Term Consultant. Long term consultant, no end date, with good job stability. There is always potential for conversion to FTE status with the client for the right employee upon business needs. Almost all of the positions within this client start off as a consultant due to being a Fortune 100 company.


Job Duties:

  • Review and abstract data from medical records for HEDIS and similar measures to support quality improvement initiatives
  • Perform market-specific data entry, ensuring accuracy and attention to detail in data collection processes
  • Maintain strict adherence to HIPAA standards and confidentiality of protected health information, reporting critical incidents as required
  • Support data mining initiatives by identifying key data elements within multiple documentation systems
  • Provide administrative support for special projects, including making in-bound and out-bound calls to request medical records, verifying contacts, and assisting with quality staff inquiries
  • Assist in identifying gaps in care and opportunities for improvement related to Star/HEDIS measures
  • Partner with leadership, administrative, and clinical staff to address trends that could impact quality outcomes
  • Track, trend, and communicate barriers that may affect clinical quality, such as inconsistent coding or lack of follow-up
  • Conduct in-bound and out-bound calls for quality requirements including, but not limited to medical records requests, contact verification
  • Receive and respond to incoming Clinical Quality inquiries from all communication venues: e.g. phone and fax queue, TruCare, or department e-mail box


Requirements

  • LPN License
  • High school diploma or equivalent
  • Minimum 2 years of experience with HEDIS
  • Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, Adobe)
  • Strong knowledge of managed care and clinical quality standards
  • Ability to pass a background check and drug test


Highly Preferred

  • Large corporation experience
  • Health plan / managed care / healthcare industry experience
  • Proficiency in reviewing and abstracting medical records with a high degree of accuracy


About Us

The CSI Companies is a recruiting firm established in 1994 that has been awarded “Best of Staffing” for 8 years in a row. We provide outstanding services to the world’s leaders in the healthcare field as well as other organizations. For consideration, please submit your resume with all of your relevant experience included on it for immediate consideration. Only those candidates identified for an interview will be contacted.


Benefits Offered:

  • Weekly pay
  • Medical, dental, and vision coverage
  • Voluntary Life and AD&D coverage
  • Paid Training
  • Opportunity for advancement upon performance and availability

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