HEDIS Quality Reviewer

Job Summary:

• The primary function of the Clinical Quality Reviewer - Seasonal is to conduct audit of medical charts for compliance with HEDIS, QARR, client Star measure specifications.
• This position will be an integral part of the annual Medical Record Review project required to report HEDIS/QARR measures to the client.
• The role is seasonal and will be needed from November of the measurement year through May of the reporting year, approximately seven months.
• The position may require travel within the five boroughs.

Product of Role & Responsibilities:

• Maintain knowledge of medical record review and EMR systems.
• Maintain up-to-date knowledge of HEDIS, QARR and Star specifications.
• Distribute requests for records and schedules appointments with provider offices to ensure timely completion of duties to meet internal and regulatory standards and requirements.
• Perform clinical audits via EMR, in-house paper medical records, on-site provider visits to collect documentation of measure compliance.
• Data enter accurate and timely findings in the appropriate system(s) in accordance with established documentation standards to ensure integrity of member services provided over the continuum of care and over time.

Required Skills & Experience:

• Clinical background: Health Educator, LPN, RN, LMSW or LCSW with a minimum of two years HEDIS review experience.
• Experience with medical record review working on HEDIS/QARR in a managed care or health plan setting.
• Proficient in Microsoft Office applications including Word, Excel, PowerPoint and Access.

Core Competencies:

• Integrity and Trust.
• Customer Focus.
• Functional/Technical skills.
• Written/Oral Communication.

Additional Requirements:

• Ability to travel within the service area.