HEDIS Medical Review Analyst

Vega Consulting Solutions is seeking a qualified RN/LPN with experience in HEDIS reporting and overread process experience. The ideal candidate will have a robust understanding of healthcare quality metrics and a proven track record of accurate data abstraction and interpretation. Applicants must be detail-oriented and able to work independently while maintaining a high level of accuracy. Prior experience in HEDIS and overread review is essential for this role.

Licenses/Certifications: RN - Registered Nurse - State Licensure And/or Compact State Licensure RN-VA, DC and or MD Upon Hire Req

• The Clinical Medical Review Nurse (an RN or LPN with clinical experience) will report to the Clinical Support Supervisor HEDIS and be part of the Quality Team.
• The main duties include conducting thorough HEDIS overreads in line with NCQA guidelines. Additional tasks involve helping with Medical Record Retrieval for HEDIS and Risk Adjustment, participating in internal audits for Supplemental Data, and supporting other needs within the Quality Department.

REQUIRED:

• HEDIS EXPERIENCE.
• 3 years clinical experience, and 5 years HEDIS and Overread experience.
• Efficiently over-read medical record abstractions performed by the HEDIS abstraction staff on a daily basis according to HEDIS specifications and company training guidelines.
• Complete the over-read process in the Software Application, including comments if errors are found. Correct errors identified through over-read process, including a re-review of charts that may contain similar errors.
• Identify and report abstraction errors and provide measure re-education with the abstractor.
• Utilizes various software applications to support HEDIS operations by entering data and / or changing chase status for the identified chase(s).
• Maintains productivity level as determined by the QI Department.
• Maintain compliance with all HIPPA and member confidentiality requirements.

If you have the HEDIS experience, Pls select Apply Now and a Vega Staffing specialist will reach out to you!

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