Job Title: HEDIS Abstractor - Nurse
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).