Quality Audit Specialist

Position Title: Quality Audit Specialist

Work Location: Remote (except NY, CA, AK or HI)

Assignment Duration: 6 Months

Work Arrangement: Remote

Position Summary:

Annually we report Healthcare Effectiveness Data and Information Set (HEDIS), this requires a medical record retrieval process and nurses are needed to conduct abstraction of medical records.

Key Responsibilities:

* Apply structured auditing criteria to abstract medical records, and accurately enter the results of chart audits into the healthplans database.

* Abstract medical record documentation submitted for HEDIS measures, used annually for reporting to National Committee for Quality Assurance (NCQA). The HEDIS measures are used to assist in measuring quality of health care provided to healthplan members.

* Maintains productivity level with less than a 5% error rate in record abstraction and data entry on an ongoing basis.

* Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.

* Maintain complete confidentiality of company related business.

* Maintain effective communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

Qualification & Experience:

* Registered Nurse (RN) with unrestricted license in state or Licensed Practical Nurse.

* 3+ years relevant experience.

* Experience in utilization review, quality assurance, and/or medical record and site review audits.

* Knowledge of medical terminology standard medical practices, formal quality improvement process, and federal, state, accreditation regulations and standards.

* Verbal and written communications skills.

* PC proficiency to include Word and Excel.

PREFERRED JOB REQUIREMENTS:

HEDIS abstracting clinical information experience.