Virginia Premier Health Plan, Inc.

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HEDIS Nurse Reviewer/Auditor

HEDIS Nurse Reviewer/Auditor

Job Locations 
US-VA-Glen Allen
Job ID 
2017-4336

Job Description

Overview

The HEDIS Nurse Reviewer/Auditor role will be responsible for the coordination, on-site and telephonic data collection, and data entry and/or uploading of HEDIS data abstracted from medical records. This incumbent is also responsible for yearlong auditing/over reading of HEDIS medical records. The sole purpose of this position is for HEDIS data management and related activities, as assigned. Travel is required. This is an in office Richmond VA based position.

 

Responsibilities

Primary Reviewer responsibilities include:

  • Planning, organizing and coordinating HEDIS data abstraction activities to include, but not limited to:
    • Scheduling and coordinating on-site medical record reviews
    • Conducting HEDIS Education Site Visits with Providers and Staff
    • Conducting medical record reviews
    • Uploading or data entering outcomes
  • Ensuring that HEDIS processes and outcomes comply with all applicable accreditation standards and regulatory requirements
  • Providing clinical quality management and ad-hoc reporting services, as assigned
  • Working with the Team Lead, Senior Manager, Director and other designated staff to identify and share best practices and opportunities for quality improvement

Primary Auditor responsibilities include:

  • Serve as a Subject Matter Expert for the department
  • Year-long over reading/auditing of medical records loaded in the supplemental database and during the annual HEDIS project
  • Where deficiencies are identified, abstractors will be retrained
  • Assist with educating providers on their HEDIS report cards and gap in care reports
  • Other HEDIS related activities, as assigned

 

Qualifications

MINIMUM EDUCATION REQUIREMENTS 

  • Current and Valid Registered Nurse with a license to practice nursing in the Commonwealth of Virginia

SPECIAL KNOWLEDGE AND/OR SKILLS 

 

 

  • Completion of at least one HEDIS project (4 to 6 months)
  • Medical record abstraction experience
  • Ability to negotiate with practitioners and providers
  • Ability to communicate effectively verbally and in writing
  • Computer literate
  • Exposure to ICD-10 and CPT4 coding

 WORK BACKGROUND/EXPERIENCE 

  • HEDIS experience, preferably in a managed care environment

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position.

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

Our mission is to inspire healthy living within the communities we serve!

 

About Us

Virginia Premier is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

Equal Opportunity Employer All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

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