Clinical Quality Specialist

2 days ago


Baltimore, Maryland, United States TEKsystems Full time
Job Title: Clinical Quality Specialist

We are seeking a highly skilled Clinical Quality Specialist to join our team at TEKsystems. As a Clinical Quality Specialist, you will play a critical role in ensuring the quality and accuracy of medical records and data.

Key Responsibilities:
  • Retrieve medical records via EMR or fax request, ensuring compliance with HIPAA and member confidentiality requirements.
  • Conduct medical record abstraction and research during the medical record review project.
  • Utilize extensive knowledge of HEDIS measures to facilitate medical record abstraction for gap closure and additional data gathering.
  • Maintain productivity level as specified by the QI Department.
  • Ensure compliance with all HIPAA and member confidentiality requirements.
Requirements:
  • Bachelor's degree in Nursing, Associates Degree in Nursing, or Diploma in Nursing.
  • 5 years of recent HEDIS abstractions/overreads experience in the payer/health insurance side of HEDIS or with a HEDIS vendor.
  • At least two consecutive HEDIS seasons with the same company.
  • 2 years clinical experience and good understanding of medical terminology.
Preferred Qualifications:
  • Current knowledge of clinical practices and related medical policies.
  • Strong organizational skills, ability to prioritize responsibilities with attention to detail.
  • Experience in using Microsoft Office, Excel, Word, PowerPoint, etc., and web-based technology.

TEKsystems is an equal opportunity employer and welcomes applications from diverse candidates. We are committed to creating an inclusive work environment that values diversity and promotes equal opportunities for all employees.



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