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HEDIS Abstractor - Nurse (REMOTE)

Job Description

Job Title: HEDIS Abstractor - Nurse


Location: Remote


 


Job Description:


Summary:


Candidate will work with the HEDIS team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific data base.


If necessary the medical record review is conducted on site in provider office or hospital institution. Local travel may be required.


This candidate will be required to handle a high volume of telephonic interaction with provider offices.


Candidates must follow up on requested medical records with providers. Must keep excellent documentation of research and contact information. Candidate must pass a medical record abstraction test prior to starting actual record reviews.


 


Major Duties And Responsibilities:


  • This is a high production environment and candidates must adhere to measured productivity requirements, module testing and at times retesting to meet minimum requirements.

  • Sharing of department responsibilities as assigned.

  • Required to perform research on internal claims systems.

  • Must be flexible and willing to develop and share strategies to accomplish goals.

  • Work under the supervision of Anthem internal staff and designated lead in order to achieve goals and keep the project moving.

  • Reviews require data analysis and research within the Anthem data systems.

  • Candidates must have excellent skill set to read and interpret physician handwriting.

  • Candidates must live within an acceptable commuting distance and reliable transportation is required.

  • Work attire is professional casual. Candidates must have critical thinking skills as they will conduct research in a thoughtful and methodical search in order to locate specific claim information.

  • Research includes all resources provided in order to find best information.

  • Examples of deep dive research would be based on Anthem specific platforms (i.e. Immunization registries, local claims system membership and defaulted claim information).


 


Job Requirements

Education And Experience:


  • Requires a licensed nurse; RN, LPN, LVN, Licensed professional graduate of an accredited school of nursing.

  • Candidates must have computer skills and analysis capabilities in order to navigate CPT4 code and ICD9 and ICD10 DX based on HEDIS Technical Specification requirements.

  • Candidates must have an understanding of codes for services based on diagnosis and procedure.

  • They must be research and detail oriented with the tenacity to find claim specific data for a specific measure within a given period of time.

  • Knowledge of Microsoft office is required.

  • Requires effective written, oral, and interpersonal communication skills.

  • It is preferred that candidates have basic Excel skills and the ability to type 30-40 WPM.

  • Prior HEDIS experience a plus.

Job Snapshot

Location US-CT-Windsor
Employment Type Full-Time Employee
Pay Type Hour
Pay Rate N/A
Store Type Health Care
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Company Overview

BCforward

BCforward is a global IT consulting and workforce fulfillment firm that provides services and resourcing for leading businesses and government organizations. For 20 years our professionals have helped clients achieve their strategic goals. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work. Learn More

Contact Information

US-CT-Windsor
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Snapshot
BCforward
Company:
US-CT-Windsor
Location:
Full-Time Employee
Employment Type:
Hour
Pay Type:
N/A
Pay Rate:
Health Care
Store Type:

Job Description

Job Title: HEDIS Abstractor - Nurse


Location: Remote


 


Job Description:


Summary:


Candidate will work with the HEDIS team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific data base.


If necessary the medical record review is conducted on site in provider office or hospital institution. Local travel may be required.


This candidate will be required to handle a high volume of telephonic interaction with provider offices.


Candidates must follow up on requested medical records with providers. Must keep excellent documentation of research and contact information. Candidate must pass a medical record abstraction test prior to starting actual record reviews.


 


Major Duties And Responsibilities:


  • This is a high production environment and candidates must adhere to measured productivity requirements, module testing and at times retesting to meet minimum requirements.

  • Sharing of department responsibilities as assigned.

  • Required to perform research on internal claims systems.

  • Must be flexible and willing to develop and share strategies to accomplish goals.

  • Work under the supervision of Anthem internal staff and designated lead in order to achieve goals and keep the project moving.

  • Reviews require data analysis and research within the Anthem data systems.

  • Candidates must have excellent skill set to read and interpret physician handwriting.

  • Candidates must live within an acceptable commuting distance and reliable transportation is required.

  • Work attire is professional casual. Candidates must have critical thinking skills as they will conduct research in a thoughtful and methodical search in order to locate specific claim information.

  • Research includes all resources provided in order to find best information.

  • Examples of deep dive research would be based on Anthem specific platforms (i.e. Immunization registries, local claims system membership and defaulted claim information).


 


Job Requirements

Education And Experience:


  • Requires a licensed nurse; RN, LPN, LVN, Licensed professional graduate of an accredited school of nursing.

  • Candidates must have computer skills and analysis capabilities in order to navigate CPT4 code and ICD9 and ICD10 DX based on HEDIS Technical Specification requirements.

  • Candidates must have an understanding of codes for services based on diagnosis and procedure.

  • They must be research and detail oriented with the tenacity to find claim specific data for a specific measure within a given period of time.

  • Knowledge of Microsoft office is required.

  • Requires effective written, oral, and interpersonal communication skills.

  • It is preferred that candidates have basic Excel skills and the ability to type 30-40 WPM.

  • Prior HEDIS experience a plus.

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