HEDIS Reviewer II

Please note: Actual location may vary., RI

Contract

Summary:

Participates in the member and provider outreach, collection, and review of medical records to abstract clinical information for HEDIS quality reporting. Training will be provided prior to the start of the assignment.

Duties:

• Outreach to members to complete survey to address Social Determinants of Health (SDoH) barriers and provide helpful resources

• Outreach to members and clinical providers to effectively coordinate care, obtain medical records and ensure patients receive preventive and chronic disease management services. The goal of these messages is to remind providers, identify if any screenings have already been performed and, if they have not been completed, to assist in any way possible to complete the screenings.

• Search for relevant HEDIS records from databases, review medical records using HEDIS technical specification criteria or internal guidelines, and make annotations via Adobe PDF.

• Ensure accurate and complete documentation of required information to meet risk management, regulatory, and accreditation requirements.

• Perform duties for additionally adhoc projects such as provider outreach to verify demographics and faxing providers.

Experience:

• Complete 60-75 outreach calls to members per day to address HEDIS gaps and provide resources on Social Determinants of Health

• Use multiple platforms and tools to search for relevant member records

• Complete assigned research lists, fax lists, and calls lists each day

• Work with provider offices as needed to schedule/confirm appointments, follow up on medical record submission, and provide patient rosters

• Locate and review ALL assigned medical charts, perform abstraction, copy all supporting documentation per specifications and data enter into the applicable software system ALL assigned abstracts.

• Prioritize and accurately complete tasks within established times

• Identifying trends and documentation of areas for improvement

• Maintaining project productivity levels while maintaining accuracy requirements for abstraction and data entry activities

Education:

High school diploma or GED

Skills:

HEDIS, data entry

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit ( .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.