Job Description
Job Description: Position Purpose: Lead data collection and abstraction for company quality measures, including HEDIS, CMS, CHIPRA and/or any other custom measurements.
Education/Experience: Associate's degree in related field or equivalent experience. Bachelor degree preferred. 4+ years of nursing, medical assistant, medical coding or data management experience. Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards) preferred. Advanced knowledge of Microsoft Applications, including Excel and Access.
Licenses/Certifications: Current state's RN or LPN license preferred.
Responsibilities:
- Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards
- Review medical records and abstract data for HEDIS and other measure sets in compliance with standards
- Track and report on issues and outcomes related to abstractions and over-reads
- Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required
- Perform other quality initiatives as necessary
Comments for Vendors: I am in need of 6 contigent remote workers in the US for HEDIS until Dec 2025 for pursuit and abstraction.
EEO:
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
Centene Job Description Position Purpose: Lead data collection and abstraction for company quality measures, including HEDIS, CMS, CHIPRA and/or any other custom measurements.
Education/Experience: Associate's degree in related field or equivalent experience. Bachelor degree preferred. 4+ years of nursing, medical assistant, medical coding or data management experience. Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards) preferred. Advanced knowledge of Microsoft Applications, including Excel and Access.
Licenses/Certifications: Current state's RN or LPN license preferred.
Responsibilities:
- Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards
- Review medical records and abstract data for HEDIS and other measure sets in compliance with standards
- Track and report on issues and outcomes related to abstractions and over-reads
- Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required
- Perform other quality initiatives as necessary
Story Behind the Need - Business Group & Key Projects
Health plan or business unit
Team culture
Surrounding team & key projects
Purpose of this team
Reason for the request
Motivators for this need
ny additional upcoming hiring needs?
dditional need for temps due to HEDIS needs.
Work will be mostly individual but will have support as needed.
Weekly and bi weekly team meetings Typical Day in the Role Daily schedule & OT expectations
Typical task breakdown and rhythm
Interaction level with team
Work environment description
Heavily focused on abstraction. Responsible for collecting medical records by looking through claims and outreaching to providers, handling pends from Vendors, Pulling charts from EMRs.
Compelling Story & Candidate Value Proposition What makes this role interesting?
Points about team culture
Competitive market comparison
Unique selling points
Value added or experience gained
Candidate Requirements Education/Certification Required: 2 or 4 year degree Preferred: Licensure Required: LPN, RN or 5 years abstraction Preferred: Years of experience required
Disqualifiers
Best vs. average
Performance indicators
Must haves: Abstraction experience, HEDIS background
Nice to haves: Working with vendors-Datafied, Datavant. Familiar with QMRM
Disqualifiers:
Performance indicators: Number of abstractions per hour, 95% compliancy rate. Top 3 must-have hard skills
Level of experience with each
Stack-ranked by importance
Candidate Review & Selection
1 2 3 Candidate Review & Selection Shortlisting process
Second touchpoint for feedback
Interview Information
Onboard Process and Expectations
Projected HM Candidate Review Date: Number and Type of Interviews: 1 Extra Interview Prep for Candidate: No Required Testing or Assessment (by Vendor): No Manager Communication Preferences & Next Steps Background Check Requirements (List DFPS or other specialty checks here)
No Do you have any upcoming PTO?
No Colleagues to cc/delegate
No Mindlance
Job Tags
Hourly pay, Temporary work,