HEDIS Audit Nurse

Location: Houston, TX
Date Posted: 09-13-2018
HEDIS Audit Nurse (RN or LVN) – Managed Care
Houston, TX 
*** This is a Full Time, Benefits Available, CONTRACT-TO-HIRE opportunity,
expected to convert to a Permanent / Direct Hire position after established time-frame! ***

HEDIS Audit Nurse Job Summary:
  • The HEDIS Audit Nurse will report the quality and compliance of Preventative/Chronic care services provided to health plan members and ACO beneficiaries.
  • Perform medical record audits for all practitioners in the organization
  • Abstract HEDIS/STAR measures through medical record review according to current NCQA specifications
  • Abstract medical records for ACO GPRO Quality Measures per CMS measure specifications
  • Internal audits to ensure accuracy of abstracted HEDIS and GPRO measures per measure specifications
  • Enter quality reporting data for Medicare Advantage Plan members and ACO beneficiaries in Provider Portal
  • Review and interpret clinical documentation obtained from medical records for compliance to insure documentation of services meets quality standards criteria
  • Educate providers on HEDIS and ACO GPRO Quality measures criteria for continued improvement in Quality Reporting initiatives
  • Receive ongoing educational training, as needed, based on changes in quality standards and criteria set forth by NCQA and CMS
HEDIS Audit Nurse Background:
  • Valid, unrestricted state nursing license (L.V.N. or R.N.).
  • Possess at least 1 year recent experience in HEDIS/GPRO chart abstraction; experience must be from the last 3-5 years.
  • Ability to review and extract significant data from medical records.
  • Knowledge and experience of medical terminology, and medical record systems.
  • Knowledgeable of the Health Plan Employer Data Information Set (HEDIS), as well as standards and reporting requirements for Medicare, Medicaid, and applicable state plans.
  • Must be computer literate and knowledgeable in MS Office, E-mail and EMR systems, and multiple additional programs including word processing, and data management.
  • Possess superior verbal and written communication skills, able to interface with business and medical professionals.

® “HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).”
Erik Berg
443.470.8240 (CALL – TEXT – FAX)
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