Job Summary of the RN / Registered Nurse / HEDIS / Coder:
This position will involve training, education, review of records to encompass a variety of initiatives. The nurses will be expected to participate in provider and hospital visits to educate, train and review medical records to determine appropriateness of documentation for select conditions.
• Proper coding of the patient’s condition.
• Physician signature requirements are met (CMS guidelines).
• Patient identification documented in the medical records.
• Verify and help providers close treatment opportunities (HEDIS/Stars measures).
• Assist and train providers on how to close diagnoses gaps.
• Train providers on the use of HEB.
• Perform clinical reviews with knowledge of body systems, anatomy and physiology.
• In addition, contractors will assist other departments, consultants when visiting providers to discuss a variety of HEDIS/Stars related issues not limited to high risk medications for example.
• Conduct other activities as assigned which may include other initiatives beside RMRA and Stars.
• Generate summary of activity as requested.
• Develop and maintain an effective professional working relationship with providers.
• Contact or answer questions (educate) for in-state and out-of-state providers.
Qualifications of the Registered Nurse (RN) / HEDIS / Coder:
• R.N. licensed in Michigan; BSN degree preferred; Associate Degree required
• Proficient in PC and MS Office skills, particularly Word and Excel
• Effective communication skills, written and verbal
• Working knowledge of CMS requirements
• Audit and medical chart review experience preferred
• Excellent interpersonal skills necessary to interact with all levels of personnel
• Working knowledge of HEDIS measures and NCQA required
• Valid MI driver’s license; willing to drive to provider locations
• Have a dependable vehicle every work day be willing to travel five days a week
• Valid MI driver’s license; willing to drive to various provider locations throughout the State of MI.
• Required to travel 3-4 days a week.
FOR MORE INFORMATION, PLEASE CONTACT:
Senior Staffing Manager
A-LINE STAFFING SOLUTIONS
877-782-3334, EXT 229 (Toll Free)
KEY WORDS: RN, registered nurse, HEDIS, utilization review, NCQA, coder, medical coding, ICD-9, CPT coding, CPC, certified professional coding, quality assurance, chart audit, medical chart review, healthcare effectiveness data and information set, Medicare (CMS)