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Jobs or company...
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Medical Review Quality Specialist - Contract - Remote - from Maryland/ VA and DC ONLY

Salary undisclosed

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Dice
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Medical Review Quality Specialist


Elite Technical is seeking nine (9) Medical Review Quality Specialist to support our Healthcare Payor customer in the Baltimore Area. Their main duties include chart retrieval and conducting thorough medical record reviews using proprietary tools and software within HEDIS measurement/standards. The role requires extensive analysis / critical thinking abilities in order to accurately and promptly abstract medical records for gap closure and other data collection, all while adhering to HIPAA Privacy and Security standards. Responsibilities also include retrieval follow-up and escalating issues as needed. Expertise in HEDIS and Quality Measures is used to meet productivity and quality targets, enhance measure compliance, and improve rate submissions according to NCQA guidelines and technical specifications. ESSENTIAL FUNCTIONS: 50%
- Retrieve medical records via EMR or fax request, ensuring compliance with all HIPAA and member confidentiality requirements.
- Call provider offices to request or validate facility and provider addresses, and/or collect medical records for the HEDIS project.
- Upload records upon receipt.
- Document all outreach efforts.
- Maintain productivity level as specified by the QI Department. 50%
- Conduct Medical Record Abstraction and Research during the Medical Record Review Project.
- Use various software applications to support HEDIS operations by entering data and/or changing chase status for the identified chase(s).
- Utilize extensive knowledge of HEDIS measures to facilitate medical record abstraction for gap closure and additional data gathering.
- Create and research Pends. Maintain productivity level as specified by the QI Department
- Ensure compliance with all HIPAA and member confidentiality requirements.
- Perform all other assigned duties. Although primarily remote, we are seeking candidates that reside in the Maryland/Baltimore County area for onsite activities (either corporate office or provider visits 1x per month) in or around Canton or Owings Mills MD. Additionally, there is mandatory onsite training week of Jan 27, 2025 that is required for 5x onsite (M-F).

<>Required Skills</>


-Must have a medical certification. Open to any certifications (Certified MA, RN, LPN, or others)
-Willing to accept either (1) recent AS or BS graduates in Nursing with NO Hedis experience or (2) non-degree / experience professionals (3+ years exp) with a minimum of 2 HEDIS seasons experience.
- Must have strong medical records review experience
-Must have strong analysis and critical thinking expertise
-Must have strong medical/clinical experience and good understanding of medical terminology.
Preferred:
-Recent HEDIS abstractions / overreads experience in the payer/health insurance side of HEDIS or with a HEDIS vendor (ex. Cotiviti, Inovalon, Reveleer).

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
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