Req ID: 19210BR
This is a work at home position in the Southeast Region of the United States. Candidates must live FL, GA NC, SC, OR TN.
Candidates must be a licensed nurse (LPN/LVN or RN) and have at least 1 year of experience working with HEDIS measures.POSITION SUMMARY
Supports Healthcare Effectiveness Data and Information Set (HEDIS) Data Collection Processes and related regulatory/contractual/performance guarantee/audit requirements. Participates in related quality improvement processes and initiatives supporting NCQA accreditation and Medicare Stars Ratings and is accountable for effective data collection, abstraction, data entry and management of support/contract staff in assigned geographic market(s).
Position Summary
The Medical Record Subject Matter Expert position supports Healthcare Effectiveness Data and Information Set (HEDIS) Data Collection Processes and related regulatory/contractual/performance guarantee/audit requirements. Participates in related quality improvement processes and initiatives supporting NCQA accreditation and Medicare Stars Ratings and is accountable for effective data collection, abstraction, data entry in assigned geographic market(s)
Fundamental Components:
- Participates in review of Pursuit Strategy, Timeline and Important Market/Measures documents and submits recommended to changes to management team
- Assists with development, review and testing of Training Materials and review of Provider Logic, DARTH letters and modules
- Provides consultation on effective use of local staff, temporary/seasonal staff and/or medical record retrieval vendors as applicable
- Compiles list of large provider group data pulls for pre-load in assigned markets;and verifies any special handling needs
- Works with local Network contacts as needed
- Performs onsite retrieval of medical records as needed
- Monitors and ensures 100% compliance with use of negative reason codes
- Monitors data collection efforts and accreditation status in assigned markets on an ongoing basis
- Ensures review and legal approval of provider agreements related to EMR or record review in assigned markets
- Ensures 100% completion of onsite data collection by the contract nurses/copy vendors in assigned market(s)
- Problem solves team issues regarding HEDIS data collection and seeks appropriate supervision
- Provides reporting on providers and medical groups
- Working with multiple systems, shared drives, web applications and programs to support HEDIS data collection processes (DARTH, HEDIS web applications, VERISK, E-TUMS, ASD, EPDB, ATV, RUMBA, etc.)
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
- Effective communication skills, both verbal and written
- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
- Work requires the ability to perform close inspection of hand written and computer generated documents as well as dual pc monitors
- Typical office working environment with productivity and quality expectations
BACKGROUND/EXPERIENCE
- 4 - 6 years HEDIS data collection and medical record abstraction experience
- Managed Care experience preferred
EDUCATION
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Quality Management/ is desired
Managed Care/Managed Healthcare Professional is desiredLicensed Professional Nurse license (LPN/LVN)ORRegistered Nurse (RN) license is requiredFUNCTIONAL EXPERIENCESFunctional - HEDIS Measures/1-3 Years RequiredFunctional - Communications/Provider communications/1-3 Years
Functional - Information Technology/Computer operations/1-3 Years
Functional - Nursing/Quality Management/1-3 Years
Functional - Quality Management/Quality Management/1-3 Years
TECHNOLOGY EXPERIENCES
Technical - Aetna Applications/Enterprise Provider Database System/1-3 Years
Technical - Aetna Applications/Aetna Strategic Data Warehouse/1-3 Years
Technical - Aetna Applications/DARTH/1-3 Years
REQUIRED SKILLS
Leadership/Collaborating for Results
Technology/Leveraging Technology
Telework Specifications:
Prefer Florida location but if strong candidate can be located in any state in SE Region
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Job Function: Quality Management