Active Florida Nursing License with two (2) years of related work experience

• Must have previous medical record / quality review experience; HEDIS/STARS preferred
• Must be proficient in Microsoft Office (Word, Excel, Outlook, and PowerPoint) as well as Internet research skills
• Ability to communicate clearly verbally and in writing
• Organizational skills are very important; must be able to work independently to complete tasks with minimal direction.

Preferred:

• Disease management experience is helpful
• Recent experience in medical record reviews, data collection for HEDIS / Stars

Job Description:

• Perform medical record reviews to support improvement and compliance, abstract HEDIS data, to include over-read of reviews, working collaboratively with internal HEDIS STARs Team and the Quality Team.
• Perform administrative functions to include; medical record request, faxing and calls to members and providers as needed.
• Maintain organized, updated reporting of activities with clear documentation.
• Required to track, monitor and report on the status of records and volume of work.
• Complete claim research to identify the service performed, dates of service, provider type, and place of service.
• Research may include multiple systems and reports.