HEDIS Quality Audit Specialist in Albuquerque at CRS Group

Date Posted: 11/4/2019

Job Snapshot

  • Employee Type:
    Contractor
  • Location:
    Albuquerque
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    11/4/2019

Job Description

HEDIS Quality Audit Specialist
Duration: 6 months contract
Location: Albuquerque, NM 87109
Overview: The CRS Group is currently looking for a HEDIS Quality Audit Specialist for one of our clients in the Albuquerque area. The CRS Group is a nationwide Staffing Firm who works primarily with Fortune 500 and Fortune 1000 corporations.
Job Description:
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.
Duties and Responsibilities:
  • Apply structured auditing criteria to abstract medical records, follow defined procedures for saving approved medical record documentation and accurately enter the results of chart audits into the health plans database, Quality Spectrum Hybrid Reporter (QSHR).
  • 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 health plan 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.
  • Qualifications:
  • Registered Nurse (RN) or Licensed Practical Nurse (LPN) with unrestricted license in state.
  • 3 years clinical experience.
  • 2 years' 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 including interpersonal skills for meeting with physicians and office staff and representing the company using diplomatic/professional demeanor
  • PC proficiency to include Word and Excel.
  • 3-year HEDIS abstracting clinical information experience preferred
  • crs_scapozzi
    ss # 85812
    Qualified applicants will receive consideration for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or genetic information.

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