HEDIS Nurse / RN / LPN
Health Care | Austin, TX | Contract
HEDIS REVIEW NURSE / RN / LPN
InGenesis Solutions has an exciting opportunity for a contract HEDIS Review Nurse / RN / LPN to work with our customer located in Austin, TX. In this role, you’ll be managing a caseload consisting of provider locations for retrieving medical records and for conducting Healthcare Effectiveness Data and Information Set (HEDIS®) medical record chart abstractions, data entry, and quality reviews. This position requires computer skills as well as knowledge of clinical aspects of preventive care and chronic conditions with the ability to apply the learned HEDIS technical specifications as indicated. This contract will start in January and go through mid-May!
- Manage an assigned caseload of provider locations and provide verbal and written progress reports regarding the status of each provider’s submission of requested medical records.
- Request medical records via most appropriate method, depending on each provider (fax, email, mail or site visits, using secure external drive or scanning, etc.) to abstract medical record documentation for Health Effectiveness Data and Information Set (HEDIS).
- Organize, schedule, and conduct on-site medical record abstraction visits as needed.
- Communicate with assigned providers to ensure compliance to requests.
- Work with peers, leadership, and other departments as needed to ensure timely retrieval and abstraction of medical records.
- Convert files to usable .pdf documents for abstraction.
- Correctly name, save, and manage files on the Shared Drive for medical records and other project documentation as assigned.
- Following the HEDIS Technical Specifications, obtain, analyze, and evaluate medical record documentation submitted for HEDIS measures [annual National Committee for Quality Assurance (NCQA) quality profile that measures quality of health care provided to members].
- Identify and label in pdf medical records all pertinent data needed to comply with HEDIS Technical Specifications.
- Accurately perform data entry on audit system, Quality Spectrum Hybrid Reporter (QSHR), of components identified in the medical record.
- Assist in developing criteria for medical record and site reviews. Assist in developing educational and training materials as requested.
- Assist in identifying barriers, planning interventions, and implementing activities to enhance and improve provider medical record and HEDIS documentation.
- Perform quality reviews of peer performance relating to medical record abstraction documentation.
- Utilize remote applications such as laptop, scanner and other devices.
- Other duties as assigned (may include administrative functions such as RightFax).
- 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 and peers regarding development within areas of assigned responsibilities and perform special projects as required or requested.
- Registered Nurse (RN) or Licensed Practical Nurse (LPN) with unrestricted Texas license.
- 3 years clinical experience.
- Knowledge of medical terminology, standard medical practices,
- Verbal and written communication skills including interpersonal skills for meeting with physicians and office staff and representing the company using diplomatic/professional demeanor.
- PC proficiency to include Word, Excel, Outlook, Adobe Pro, and folder navigation and management skills.
- Willing to travel using personal transportation.
- Competitive Salary
- Paid Time Off
- Paid Federal Holidays
- Medical, Dental, Vision Health Insurance Plans
- 401K Retirement Plan
- Life and Disability Insurance
Established in 1998, InGenesis enjoys a long history of positive government and commercial relationships with healthcare industry professionals and businesses nationwide. We are the recent recipients of an Inc. 5000 award and dedicated to servicing our customers.
InGenesis is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin.