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HEDIS Specialist

Company:
AmeriHealth Caritas
Location:
Philadelphia, Pennsylvania, United States
Posted:
November 16, 2016
Description:

We have partnered with a large Health Insurance company in the Philadelphia, PA area to provide them with a HEDIS Specialist. Will consider Remote Work from Home candidates with strong HEDIS experience. Must be able to drive to the the Philadelphia offices once or twice per quarter.

Please review the below description and if you are interested please contact:

Lilit Mkrtchyan at: lmkrtchyan@relevante.biz

Description:

Under the direction of the Manager, Quality Management, the HEDIS Specialist is responsible for:

The planning, coordination and monitoring of the HEDIS/ EQRO data collection and outreach activities. The function also includes identifying and auditing medical records for gaps in care and recommending ongoing improvement and maintenance.

Coordinating the Road Map with the HEDIS team members

Reviewing the provider data to ensure accurate data :

Looking for completeness in demographics

Correct provider types

Review and signoff on provider specialty tables for roadmaps

Providing Data collection instruction to internal staff and preparing training materials for all staff

Provider training and documentation for over read process

Job-Related Experience and Skills:

Required:

RN or LPN

Understanding of Standards of Care, required

Experience with SQL, SAS or HEDIS vendor software (QSI, MEDMEAUES, McKesson)

Preferred:

HEDIS experience

Knowledge of the NCQA and HEDIS submission process

Minimum 4-5 years working with HEDIS data including:

Chart review/collection

Over read process

Admin of IRR process

Hiring of field data collection staff

Additional experience but not required:

Managing other Nurses/Chart Collection Staff

About Relevante, Inc. – the Recruiting Firm Representing the Client for this Job

Relevante is an accounting & technology direct hire recruiting and contract staffing firm. We help our Clients identify and recruit the best talent in the market and help our candidates win engaging and enriching jobs. Our Clients are some of the best companies to work for among F1000 and emerging fast growth companies in the region. Relevante has been consistently ranked as a fast growth company and one of the largest recruiting, accounting, and management consulting firms in the Philadelphia region.