HEDIS Coder/Abstractor

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The Opportunity

Description

We're looking for a HEDIS Coder / Abstractor , working in Insurance industry in Pennsylvania, United States .

• Review medical records and document to abstract clinical data for HEDIS reporting.
• Identify and extract relevant details and data within clinical documentation and make determinations or identify appropriate medical codes.
• Utilize resources and reference materials (e.g., on-line sources, manuals) to identify appropriate medical codes and reference code applicability, rules, and guidelines.
• Apply understanding of relevant medical coding subject areas (e.g., diagnosis, procedural, evaluation and management, ancillary services) to assign appropriate medical codes.
• Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable medical codes.
• Identify areas in clinical documentation that are unclear or incomplete and generate queries to obtain additional information.
• Follow up with providers as necessary when responses to queries are not provided in a timely basis.
• Utilize medical coding software programs or reference materials to identify appropriate codes.
• Read and interpret medical coding rules and guidelines to make decisions (e.g., exclusions, sequencing, inclusions).
• Assist with ensuring that the medical record collection, review, and abstractions are complete and compliant in accordance with NCQA HEDIS technical specifications and guidelines.
• Apply post-query response to make final determinations.
• Make determinations on medical charting and take initiative to complete reviews independently to avoid delays in the process.
• Apply relevant Medical Coding Reference, Federal, State, and Professional guidelines to assign and record independent medical code determinations.
• Record information, analyze data, or communicate with others.
• Utilize and navigate across clinical software applications to assign medical codes or complete reviews.

Our Client

Our client is a fast-growing industry-recognized staffing firm. Recruiting critical IT, Financial, Engineering, Healthcare, and Data Analytics talent.

With 20+ years' experience and growth.

Connections in Automotive, Healthcare, Retail, Financial & Insurance, and Professional & Business Services. Working to bring top talent together with premier organizations.

Big enough to have great opportunities. Small enough to care about finding the right one for you.

It'sabout relationships based on mutual interest. The results are low turnover, long-lasting partnerships and growth. Want to work for a company invested in your success?

Experience Required for Your Success

• High school education or equivalent experience
• 2+ years of experience supporting HEDIS and / or quality improvement, and medical coding
• Active CPC, CRC, RHIT, RHIA Coding Certification (AAPC) or CCS Certification (AHIMA)

What Do You Think?

Does your experience reflect what it takes to be successful in this role? Do the work and challenges get you excited about what's possible?