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Registered Nurse (RN) / HEDIS / Coder

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

Travel Requirements:

•    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.

Alliston Brown
Senior Staffing Manager
877-782-3334, EXT 229 (Toll Free)

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)

Apply Online
About A-Line Staffing Solutions

About A-Line Staffing Solutions

A-Line Staffing Solutions is a premier staffing company that supplies professionals to the Healthcare, Insurance, Pharmaceutical, and Information Technology industries.

Founded in 2004, A-Line Staffing Solutions has been a leader in matching talented individuals to the jobs that our clients NEED to fill. We are experts at offering creative staffing solutions to employers, and we are hiring every day.

A-Line Staffing can offer short-term, long-term and direct-hire opportunities to professionals across the United States. We hire only the most qualified and talented individuals in the country. Our recruiting, selection and stringent screening processes have strengthened our reputation for delivering quality customer service and unbeatable talent.

For our commissioned clients, A-Line Staffing closely follows the standards and practices established by The Joint Commission. For all of our clients and employees, our commitment to continual improvement combined with a strict code of ethics provides an atmosphere of respect and unparalleled professionalism.

To find out how A-Line Staffing Solutions can share our talent with you, please contact us today. We are eager to include you among our most valued and satisfied clients.

If you are a professional and would like to learn more about open opportunities in your area, please contact us today. We are always searching for talented and enthusiastic professionals
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A-Line Staffing Solutions jobsummary
  • Company:
  • Location:
    Detroit, MI
  • Job Status/Type:
    Full Time Employee
  • Job Category:
  • Occupations:
  • Work Experience:
    2+ to 5 Years
  • Career Level:
    Experienced (Non-Manager)
  • Education Level:
    Associate Degree

  • Phone:
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