HCSC Over Reader RN or LVN/LPN

SUMMARY DESCRIPTION: RN or LPN with clinical experience and will work under the supervision of the HEDIS Coordinator. They are a member of the medical record review team. The team is responsible for obtaining and performing accurate comprehensive reviews of medical records in support of The HEDIS Effectiveness Data and Information Set project. HEDIS reviews are completed in accordance with NCQA guidelines and technical specifications.

JOB REQUIREMENTS:
• Degree, Diploma or Certificate from a school of nursing with clinical experience.
• Licensed in the State of Illinois
• Knowledge of medical terminology
• Data entry and/or typing experience.
• Clear and concise written and verbal communication skills.
• PC proficiency to include Word, Excel and Lotus Notes.
• Auditing experience preferred.

DUTIES AND RESPONSIBILITIES:
• Accurately and efficiently over-read medical record abstractions performed by the HEDIS abstraction staff on a daily basis according to HEDIS specifications and BCBSIL training guidelines.
• Complete the IRR/over-read tool in the Software Application, including comments if errors are found. Correct errors identified through over-read process, including a re-review of charts that may contain similar errors.
• Identify and report abstraction errors and provide measure re-education with for the abstractor.
• Utilizes various software applications to support HEDIS operations by entering data and / or changing chase status for the identified chase(s).
• Meets with HEDIS Coordinator and / or QI Specialists to discuss HEDIS efforts, any open issues and can include IRR results.
• Maintains productivity level as determined by the HEDIS Coordinator/QI Department.
• Maintain compliance with all HIPPA and patient confidentiality requirements.
• All other duties as assigned.