HEDIS Reviewer

1 day ago

Chester, Virginia, United States A-Line Staffing Solutions Full time
Job Title: HEDIS Reviewer - Provider Outreach

Job Summary:

We are seeking a detail-oriented HEDIS Reviewer - Provider Outreach to join our remote team on a contract basis. In this role, you will play a crucial part in closing HEDIS care gaps by conducting daily outreach calls to members and providers. Your primary responsibilities will include verifying and gathering medical records, scheduling appointments, coordinating care, and addressing Social Determinants of Health (SDoH) barriers.

Key Responsibilities:

  • Conduct daily outreach calls to members to address HEDIS care gaps and provide information on Social Determinants of Health (SDoH)
  • Search for and review relevant member records using multiple databases and platforms
  • Assist providers in scheduling appointments, confirming medical record submissions, and providing patient rosters
  • Remind providers about screenings and assist in ensuring completion of required services
  • Collect and review medical records using HEDIS technical specifications or internal guidelines and annotate documents in Adobe PDF
  • Participate in ad hoc projects, such as verifying provider demographics and faxing documents
  • Complete daily tasks, including research lists, fax lists, and call lists to meet project goals
  • Ensure confidentiality and security of PHI (Protected Health Information) while adhering to HIPAA Privacy and Security rules

Qualifications:

  • HEDIS experience required
  • 1-3 seasons of outreach calls and medical record review experience
  • Call center experience is a plus (ability to handle 60-75 calls per day)
  • Strong medical knowledge and ability to read and interpret medical records
  • Computer proficiency with Microsoft Word, Excel, email, and Adobe Reader

Additional Requirements:

  • Must maintain confidentiality and organize collected data safely
  • Experience working remotely is preferred

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