Quality Audit Specialist

Quality Audit Specialist

Chicago, Illinois

This position supports the data collection of HEDIS clinical data set tied to technical specifications; auditing and review of electronic clinical records to ensure data accurately reflect medical record documentation to meet HEDIS regulatory compliance. Responsible for oversight and review of clinical data from Electronic Medical Records (EMRs) non-EMRs sources; auditing supplemental data files supplied by providers and vendors to improve HEDIS rates/results. This position impacts the integrity of the Medical Record validation process and HealthCare Effective Data & Information Set (HEDIS) Reporting. Individual must demonstrate strong multi-tasking setting priorities based upon minimal direction including:

• Strong Knowledge of Healthcare Effective Data & Information Set (HEDIS) type of reporting
• Minimum of 3 years Healthcare industry experience; healthcare data
• Strong experience with NCQA and HEDIS reporting, technical data analysis in formal audit formal audit environment.
• Understanding of NCQA HEDIS quality measures and related code value sets.
• Experience in HEDIS value sets and codes applied, including CPT II, SNOMED, LOINC, ICD, HCPCS, and other code sets.
• Strong clinical quality auditing experience
• Strong written and verbal skills; Self-starter problem solving abilities.
• Strong proficiency in MS Office Suite including Word, Excel, PowerPoint, datasets, reporting tools with good multi-tasking skills
• Strong understanding of Electronic Medical Record (EMRs) system from providers, vendors related to HEDIS interpretation
• Conducts analysis and investigation on inquiries related to medical records data collection issues
• Proven to be adept at navigating new systems and technology with little impact to your daily assignments
• Experience with Coding or Certified Coding Certification with HEDIS experience