HEDIS Coordinator- Remote (Must be Located in Pittsburgh or Surrounding Are at UPMC

Pittsburgh, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

10 Mar, 26

Salary

0.0

Posted On

10 Dec, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

HEDIS Compliance, Clinical Documentation Review, Quality Audits, Chart Abstraction, Data Entry, HIPAA Compliance, Communication Skills, Microsoft Word, Microsoft PowerPoint, Microsoft Excel, Microsoft Access, NCQA Requirements, Health Care Experience, Registered Nurse, Attention to Detail, Team Collaboration

Industry

Hospitals and Health Care

Description

UPMC Health Plan has an exciting opportunity for a HEDIS Coordinator position in the Quality Improvement department. This is a full time position working Monday through Friday daylight hours and will be a remote position. Must be located in Pittsburgh or surrounding area to be considered! Staff in this position are responsible for reviewing the clinical documentation submitted via the Novellus Care Gap Management Application and Biometric Application from network physicians and Health Plan staff, to support for HEDIS measure compliance or potential measure exclusion. Responsibilities: Adhere to the UPMC Health Plan HIPAA Compliance Guidelines. Ensure that HIPAA standards are met in all aspects of the Department functions including delegated functions. Ensure that all releases of member personal health information, which are conducted outside of the realm of Treatment, Payment, or Operations are appropriately logged. Performs in accordance with system-wide competencies/behaviors. Perform duties and responsibilities in accordance with the philosophy, standards and policies and procedures of the UPMC Health System, including conveying courtesy, respect, enthusiasm, and a positive attitude through all contacts with staff, health plan members, providers, peers, and visitors. Performs other duties as assigned. Conduct quality audits of clerical data entry tasks. Support annual HEDIS via chart abstraction and/or assistance with the over-read/auditing process. Assist with review of new HEDIS Specifications to identify measure criteria changes impacting medical record review outcomes. Assist with quarterly quality audits for reviews approved in the Novellus Care Gap Management Application and/or Biometric Application. Assist with updating/maintaining the HEDIS Measure Spreadsheet, to document review determinations for clinical documentation submitted for gap closure or measure exclusion. Review clinical documentation submitted by providers and Health Plan staff for potential HEDIS measure exclusion. Review and evaluate clinical documentation submitted by network providers and Health Plan staff through the Novellus Care Gap Management Application and/or Biometric Application for HEDIS measure compliance. Registered nurse, minimum of 5 years of health care related experience required, bachelor level preferred. Excellent verbal and written communication skills are required. Proficiency in Microsoft Word, PowerPoint, Excel, and Access preferred. Working knowledge of the National Committee on Quality Assurance (NCQA) HEDIS requirements preferred. Licensure, Certifications, and Clearances: Registered Nurse (RN) *Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state. UPMC is an Equal Opportunity Employer/Disability/Veteran

Responsibilities

The HEDIS Coordinator is responsible for reviewing clinical documentation to support HEDIS measure compliance and potential measure exclusion. This includes conducting quality audits and assisting with chart abstraction and auditing processes.