HEDIS Coordinator 1
Posting ID: JP-002662872
- Actalent Scientific is actively interviewing for fully remote Nurse Medical Managers in the Indianapolis area! Candidates are responsible for collecting member records and conduct reviews of these records by contacting providers and placing the results collected into a specific data base. 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 after 4-8 weeks of training.
These opening are all on FIRST SHIFT availability Monday-Friday offering above market pay value with one of the largest healthcare companies in the state.
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.
- Must be flexible and willing to develop and share strategies to accomplish goals.
- Required to perform research on internal claims systems.
- Work under the supervision of our clients internal staff and designated lead in order to achieve goals and keep the project moving.
- Reviews require data analysis and research within the company data systems.
- 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 the companies specific platforms (i.e. Immunization registries, local claims system membership and defaulted claim information).
- Candidates must have excellent skill set to read and interpret physician handwriting.
Education and Experience:
- Must understand medical terminology.
- Works under the direction of a HEDIS Lead as a crossover position from abstractor to researcher.
- Candidates must have prior experience with research and either HEDIS measures or auditing data submitted as claims.
- 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.
- Candidates must have basic Excel skills and must have the ability to type 30-40 WPM. Prior HEDIS experience a plus.
MA, CMA, EMR, medical assisting
Top Skills Details:
Additional Skills & Qualifications:
- Requires a Medical Assistant certification with an AS (Associate in Science) degree
- and/or has worked as office manager/ admin to a medical office
- and/or assistant to physician and nurses in reviewing of medical records, applying codes for billing/claims, processing files and submitting to insurance or other requested agencies.
We have interview times for this week and next week only; and times are filling quickly. If you or any friends/family are interested in hearing more about these opportunities, apply today and reach out to me directly AS SOON AS POSSIBLE!
Compensation is tied to the Colorado market for jobs performed in Colorado. Other locations may be subject to variances based on locations-related factors. We reserve the right to pay above or below the posted wage based on factors unrelated to sex, race, or any other protected classification.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. This temporary role may be eligible for the following:
- Medical, dental & vision
- Insurance (Basic/Supplemental Life & AD&D)
- Short and long-term disability
- Health & Dependent Care Spending Accounts (HSA & DCFSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave)
Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We’re supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
Recruiter: Karlecia Ross