HEDIS Review Nurse Specialist
3 weeks ago
A skilled Registered Nurse (RN) or Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) is required to conduct annual patient chart inspections/audits. The purpose of these audits is to ensure that healthcare providers (MDs) accepting insurance are in compliance with standards of patient care set forth by the insurance company.
Key Responsibilities:- Apply structured auditing criteria to abstract medical records, following defined procedures for saving approved medical record documentation and accurately entering the results of chart audits into the healthplans database, Quality Spectrum Hybrid Reporter (QSHR).
- Abstract medical record documentation submitted for HEDIS measures, used annually for reporting to National Committee for Quality Assurance (NCQA). The HEDIS measures are used to assist in measuring the quality of healthcare provided to healthplan members.
- Maintain a high level of productivity with less than a 5% error rate in record abstraction and data entry on an ongoing basis.
- Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies, and other applicable corporate and departmental policies.
- Maintain complete confidentiality of company-related business.
- Maintain effective communication with management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.
- Registered Nurse (RN) or Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) with an unrestricted license in the state.
- 3 years of clinical experience.
- 2 years of experience in utilization review, quality assurance, and/or medical record and site review audits.
- Knowledge of medical terminology, standard medical practices, formal quality improvement processes, and federal, state, accreditation regulations, and standards.
- Verbal and written communication skills, including interpersonal skills for meeting with physicians and office staff and representing the company using a diplomatic/professional demeanor.
- PC proficiency, including Word and Excel.
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HCSC Field Abstractor
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Clinical Chart Review RN
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Clinical Documentation Specialist
2 weeks ago
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Clinical Documentation Specialist RN
1 week ago
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El Paso, Texas, United States Jobot Full timeAbout UsJobot is a leading Academic Medical Center & Trauma Center focused on community, respect, accountability, excellence, and services. We are dedicated to providing the highest quality care and most accessible care to everyone in the community.Job DetailsRN/Registered Nurse - Clinical Documentation Specialist (CCDS)The RN Clinical Documentation...
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RN Clinical Documentation Specialist
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Clinical Documentation Specialist RN
2 weeks ago
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