HEDIS Abstractor (RN / LPN)

A New York City-based managed care company is actively seeking a licensed Registered Nurse (RN) and/or Licensed Practical Nurse (LPN) to join their growing staff as their new HEDIS Abstractor. In this role, the HEDIS Abstractor (RN / LPN) will be responsible for establishing and fostering a healthy working relationship between large physician practices, IPAs and the managed care company and providing education for HEDIS measures, appropriate medical record documentation and appropriate coding. Opportunities are available to work remotely, in the office, and/or in the field. Apply today! 

Managed Care Company

The HEDIS Abstractor (RN / LPN) will be responsible for:

• Advising and educating 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
• Collecting, summarizing, and trending provider performance data to identify and strategize opportunities for provider improvements
• Collaborating with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters)
• Developing, enhancing, and maintaining provider clinical relationship across product lines
• Partnering with Physicians / Physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education
• Providing communication, such as: newsletter articles; member education; outreach interventions; and, provider education
• Supporting quality improvement HEDIS and program studies; requesting records from providers; maintaining databases; and, researching to identify members' provider encounter history
• Participating in and representing plans at community, Health Department, collaborative and other organizational meetings focusing on quality improvement, member education, and disparity programs, as assigned
• Entering documentation of findings in identified databases
• Performing other duties, as assigned

• 3+ years of experience directly related HEDIS record collection with analytical review / evaluation and/or Quality Improvement; 1+ year of experience in a Managed Care setting
• Bachelor's Degree in Healthcare, Public Health, Nursing, Health Administration or related field
• NYS Registered Nurse (RN) and/or Licensed Practical Nurse (LPN) license
• Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
• Working knowledge of Healthcare Management Systems 
• Microsoft Office/Suite proficient (Excel, Outlook, PowerPoint, Word, etc.)
• Solid analytical, assessment, and documentation skills
• Great interpersonal skills
• Excellent communication skills (written and verbal)
• Strong attention to detail
• Highly organized

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