RN HEDIS Quality Audit Specialist
Hedis Review Nurse | Albuquerque, NM | Contract
RN - HEDIS Quality Audit Specialist
Work Location: Albuquerque, NM
InGenesis has a wonderful opportunity for an RN HEDIS Quality Audit Specialist to support our customer located in Albuquerque, NM. This is part of the work that is done annually and reported on and will require the nurse to assist in a medical record retrieval process and conduct abstraction of these records. If you meet the qualifications, please apply and a recruiter will reach out to you and answer any questions you may have about this role.
Job Duties/Responsibilities/Functions(including but not limited to)
• Apply structured auditing criteria to abstract medical records, follow defined procedures for saving approved medical record documentation and accurately enter the results of chart audits into the health plans 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 quality of health care provided to health plan members.
• Maintains productivity level 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 development within areas of assigned responsibilities and perform special projects as required or requested.
• Registered Nurse with unrestricted license in state.
• Three (3) years clinical experience.
• Two (2) years’ experience in utilization review, quality assurance, and/or medical record and site review audits.
• Knowledge of medical terminology standard medical practices, formal quality improvement process, and federal, state, accreditation regulations and standards.
• Verbal and written communications skills including interpersonal skills for meeting with physicians and office staff and representing the company using diplomatic/professional demeanor.
• PC proficiency to include Word and Excel.
InGenesis is dedicated to placing people in positions that preserve life, improve lives and inspire others. This does not happen without passionate people, skilled colleagues who are motivated to create innovative solutions and deliver superior service to our clients. Founded in 1998, InGenesis manages thousands of employees, including pioneering healthcare, science, technology and pharma professionals. The workforce solutions company includes almost half of the Fortune 500 in its nearly 300 clients. It is recognized as one of the largest healthcare staffing firms, and InGenesis is the largest minority/women owned healthcare staffing firm in North America.
We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law.