HEDIS Specialist

Experience pertaining to health care quality improvement or clinical research. Highly desired
Familiarity with ICD-9 and CPT coding. Highly desired
Experience with abstracting clinical information from medical records. Required
Clinical experience in women's health care, diabetes, pedciatrics or obstetrics. Highly desired
Experience with the use of Windows-based PC applications with emphasis on word processing, database, and spreadsheet software. Required
Knowledge of NCQA HEDIS abstracting guidelines. Highly desired
Live in Charleston, Berkeley, or Dorchester counties Required
Current unrestricted SC Licensed Practice Nurse, Certified Professional Coder, Certified Medical Records Auditor, RHIT, or RHIA
Experience pertaining to health care quality improvement or clinical research preferred;
Familiarity with ICD-9 and CPT coding preferred.

Experience with abstracting clinical information from medical records;
Clinical experience in womens health care, diabetes, pediatrics or obstetrics preferred;
The ability to consistently apply clinical audit criteria with at least a 99% inter-rater reliability;
The ability to consistently enter the results of clinical audits into a database with at least a 99% inter-rater reliability;
The ability to appropriately evaluate medical records and other health care data; Organized, accurate, detail-oriented;
Able to think and work effectively under pressure;
The ability to function effectively within multidisciplinary teams;
Experience with the use of Windows-based PC applications with emphasis on word processing, database, and spreadsheet software (e.g., MS Word and Excel) preferred;
Knowledge of NCQA HEDIS abstracting guidelines preferred; Ability to plan and organize data collection activities;
Ability to communicate effectively both orally and in writing; Knowledge of the concepts of managed health care;
Ability to establish and maintain effective and cooperative working relationship with staff and others contacted in the course of the work;
Ability to maintain confidentiality of sensitive medical information; Knowledge of The HIPAA Privacy and Security Rules
Ability to accurately complete tasks within established times; Ability to effectively prioritize multiple tasks and deadlines.

Performs medical records abstraction in support of annual The Healthcare Effectiveness Data and
Information Set (HEDIS), with duties including but not limited to:
Applies structured auditing criteria to medical records to determine compliance with standards
Maintains productivity level as determined by the Quality
Improvement Director;
Accurately enters the results of chart audits into a database
Monitors progress towards completion of the annual HEDIS chart abstraction process; Maintains a less than 1% error rate in record abstraction and data entry.
Utilizes various software applications (e.g.,, Quality Spectrum Insight, Excel and Word) to support
HEDIS operations; and
As required: visits to provider sites to identify copy and collect selected medical records
Performs additional duties as assigned.