HEDIS Abstractor

A premier managed care company located in Columbus, 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 provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. 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

• 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 
• 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
• 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 

• Certified Healthcare Professional (CHP)
• Master's Degree in Healthcare, Public Health, Nursing, Health Administration or related field