Clinical Hedis Manager

Summary

Join Reveleer, a healthcare data and analytics company, as a full-time Clinical HEDIS Manager. You will oversee HEDIS abstracting and reporting, manage RISK projects, and conduct medical record reviews. Responsibilities include training on HEDIS measures and platform usage, monitoring project status, and reviewing IRR and positive/negative hits. This role requires a professional coding certificate, 5+ years of medical records and HEDIS experience, and strong computer skills. Reveleer offers a competitive salary and a commitment to equal opportunity employment.

Requirements

• Have a professional coding certificate through AHIMA/AAPC
• Have a minimum of 5 years of hands-on medical records experience
• Have 5 Years of HEDIS experience
• Have strong computer skills and high-speed internet access at home
• Demonstrate commitment to confidentiality of patient health information
• Be professional, articulate and able to work independently
• Be able to manage teams and meet deadlines
• Be able to conduct trainings in nonstandard time frames to meet abstractor needs and training

Responsibilities

• Oversee and/or perform an accurate medical record review for all HEDIS measures
• Support and participate in process and quality improvement initiatives
• Conduct training related to HEDIS measures, platform usage, update any training materials, and function as HEDIS SME
• Monitor project status
• Work on flexible projects with variable client/project specific guidelines
• Review and facilitate IRR review
• Review all Negative / Positive hits
• Manage RISK coding projects when needed- including project status and completing chart reviews for coding projects as needed
• Analyze medical records and NLP results and validate that the clinical evidence meets the necessary requirements for submission and documentation
• Make sure the documentation accurately reflects the patient’s conditions, treatment and services provided
• Identify gaps, inconsistencies, and discrepancies in documentation that could impact patient care, quality reporting and reimbursement
• Ensure documentation aligns with accurate code assignment and follow CMS’s coding guidelines for HCC risk adjustment coding
• Maintain a deep understanding of medical terminology, disease processes, treatments, and procedures to accurately interpret and validate clinical documentation
• Safeguard the integrity and confidentiality of patient health information while handling medical records and sensitive data in accordance with HIPAA and other relevant regulations
• Foster clear communication and collaboration between different healthcare departments, ensuring that accurate patient information is shared across the continuum

Preferred Qualifications

• Have a valid nursing license (RN/LPN)
• Have knowledge of NCQA HEDIS abstracting guidelines
• Have a background in UR, QA and/or QI experience

Benefits

Salary range: $100,000 - $115,000 / annually