HEDIS Abstractor

A premier managed care company located in Martinez, GA is seeking a self-motivated and dedicated healthcare professional for a promising opportunity on their staff as a HEDIS Abstractor. In this role, the HEDIS Abstractor educates providers and supports provider practice sites in regards to the National Committee for Quality Assurance (NCQA) HEDIS measures. This is an excellent opportunity for a professional looking for remote work opportunities. Apply today!

Managed Care Company

The HEDIS Abstractor:

• Advises and educates large Provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements
• Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement
• Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters)
• Identifies specific practice needs where the company can provide support
• Develops, enhances and maintains provider clinical relationship across product lines
• Defines gaps in the company's service relationship with providers and facilitate resolution
• Leads and/or supports collaborative business partnerships, elicit client understanding and insight to advise and make recommendations
• Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education
• Provides resources and educational opportunities to provider and staff

• Bachelor's Degree in Healthcare, Public Health, Nursing, Health Administration or related field is required or equivalent work experience, including 3+ years of directly related HEDIS record collection with analytical review/evaluation and / or Quality Improvement
• One of the following certifications and/or licenses is required: Registered Nurse (RN), Licensed Practical/Vocational Nurse (LPN/LVN), Certified Coding Specialist (CCS),  Acute Care Nurse Practitioner (APRN) (ACNP-BC), Healthcare Quality and Management (HCQM) Certification or Certified Professional in Healthcare Quality (CPHQ) certification 
• 2+ years of experience in directly related HEDIS medical record review and/or Quality Improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff 
• 1+ year of experience in Managed Care
• Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
• Intermediate knowledge of Microsoft Excel, Word, Outlook, PowerPoint, and Healthcare Management Systems