HEDIS Quality Improvement Professional

3 days ago


Orlando, Florida, United States Actalent Full time

About the Role:

We are seeking a highly skilled Medical HEDIS Specialist to join our team. As a remote worker, you will be responsible for collecting member records, conducting reviews, and placing results into a specific database. This role demands handling a high volume of telephonic interaction with provider offices, performing research on internal claims systems, and developing strategies to accomplish goals.

Responsibilities:

  • Collect member records and conduct reviews by contacting providers
  • Place collected results into a specific database
  • Handle a high volume of telephonic interaction with provider offices
  • Perform research on internal claims systems
  • Develop and share strategies to accomplish project goals
  • Work under the supervision of internal staff and designated leads
  • Conduct data analysis and research within data systems
  • Read and interpret physician handwriting accurately
  • Use critical thinking skills to locate specific claim information
  • Perform deep dive research using specific platforms (e.g., Immunization registries, local claims systems)

Requirements:

This position requires an LPN, LVN, or RN license, Associate's degree in Nursing, experience with Medicaid, two seasons of HEDIS/STARS experience, critical thinking and analysis skills, tenacity for hunting down information from patient charts, typing speed of 30+ WPM, strong knowledge of Microsoft Office and Teams.

Salary: $28.00 - $32.00 per hour.

Benefits:

The company offers medical, dental, and vision insurance, critical illness, accident, and hospital insurance, 401(k) retirement plan, life insurance, short and long-term disability insurance, health spending account, transportation benefits, employee assistance program, time off/leave (PTO, vacation or sick leave).

Work Environment:

This is a fully-remote position with equipment provided, including dual screens. The work schedule is Monday to Friday, 8am to 5pm EST. The work attire is professional casual.

Location: Must live in the state of Florida as local travel and team meetings will be required.



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