Clinical Medical Review Specialist / HEDIS

Title : Clinical Medical Review Specialist / HEDIS Location : Owings Mills, MD Duration : 05 Months Job Description : Hybrid – Position is primarily remote but will be required to attend a three-four day in-person training at the client location as well as travel to local Provider offices for onsite Medical Record retrieval as needed. Overreading (may replace the abstraction function) : Accurately and efficiently over-read medical record abstractions (as performed by the HEDIS abstraction staff) within the abstraction platform on a daily basis according to HEDIS specifications and company training guidelines. Correct errors identified through the 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. Risk Adjustment : Medical Record Retrieval for Risk Adjustment, internal Supplemental Data Audit (PSV) and other Quality and HEDIS related tasks in the off-season Experience : 3 years clinical experience and 5 years HEDIS experience. We are seeking a qualified RN / LPN with experience in the payer / health insurance side of HEDIS reporting abstraction processes. The ideal candidate will have a robust understanding of healthcare (NCQA) quality metrics and a proven track record of accurate data abstraction and interpretation. Prior experience in HEDIS abstraction of medical records for gap closure within the health plan setting or prior experience with a HEDIS vendor (ex. Reveleer, Cotiviti, Inovalon) is essential for this role. Applicants must be detail-oriented and able to work independently while maintaining a high level of accuracy. Proficient skills and experience using Microsoft Office (Excel, Word, Power Point, etc.), Microsoft Teams and Outlook are required. Experience utilizing various EMR platforms including Epic, eClinical Works, Athena, Cerner, All Scripts, and Tebra to retrieve medical records is essential for this role. Proven HEDIS overreading experience for a health plan or HEDIS vendor is a bonus. Thanks & Regards, Ian Basha Zolon Tech