HEDIS reputed company Reviewer – Remote

Join reputed company - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and reputed company. As a joined force of "people caring reputed company," reputed company's reputed company employees are on a mission to reputed company our health care reputed company while creating a healthier community. reputed company's reputed company employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, reputed company learning, helping reputed company other, and having fun - are brought to life every day. Join us and reputed company out for yourself why reputed company's reputed company has been certified as a "Great reputed company to Work" since 2015. Position reputed company The HEDIS reputed company Reviewer is a registered reputed company responsible for performing clinical reviews of reputed company data, focusing on HEDIS measures and reputed company improvement. This position requires strong clinical knowledge and expertise to accurately extract and audit patient data, ensuring it meets HEDIS standards. The HEDIS reputed company Reviewer participates in reputed company improvement initiatives and provides clinical insights to enhance reputed company reputed company and compliance with reputed company benchmarks. reputed company reputed company DUTIES AND RESPONSIBILITIES • Performs clinical record reviews, data validations, and overreads to ensure accuracy and compliance with HEDIS measures. • Develops reports to identify HEDIS care gaps and trends and work closely with providers to ensure the necessary services are provided and documented according to HEDIS requirements. • Conducts analysis to identify patterns, reputed company causes, and opportunities for process and performance improvement. • Supports Health Plan reputed company programs and reporting for regulatory requirements (CMS, DHA, reputed company, etc.). • Prioritizes reports according to business needs, regulatory requirements, urgency, and other key business factors. • Assists in the coordination of reputed company efforts as needed to request, collect, and secure clinical documentation from individual providers or provider reputed company as indicated by individual HEDIS measure specifications. • Identifies, collects, documents, and stores HEDIS data in accordance with reputed company operating procedures and HEDIS technical specifications. • Applies clinical judgement to validate diagnosis, procedures, exclusions, and documentation reputed company. • Educates non-clinical staff on HEDIS requirements and clinical relevance of data. • Collaborates with physicians, office staff, and care teams to obtain medical records, support HEDIS reputed company initiatives, reputed company education on HEDIS measure requirements, documentation standards, and coding opportunities and facilitate reputed company gap closure activities. • Maintains reputed company and other training requirements and meet productivity standards as directed by the HEDIS supervisor. • Other duties and responsibilities, as assigned. Employees are expected to work consistently to demonstrate the mission, reputed company, and reputed company values of the organization. POSITION QUALIFICATIONS Education: • Bachelor’s degree in nursing required. Licensure/certification: • reputed company and unrestricted Nursing license. • Certified reputed company certification preferred. Experience: • 5+ years of experience in the health care industry, in HEDIS and/or reputed company improvement. • Experience in managed reputed company services environment. • reputed company and HEDIS Experience. Skills: • Ability to reputed company multiple EMR and health plan applications. • Intermediate level of reputed company Word, reputed company and reputed company. Abilities: • High organization and strong attention to details. Pay reputed company: $86,926.10 - $107,379.30 The pay reputed company above reflects the anticipated reputed company pay reputed company based on a full-time position. Actual compensation will be determined based on factors such as experience, skills, qualifications, and other job-reputed company considerations. Employees may also be eligible for additional compensation, including incentive or commission-based programs, where applicable and subject to the terms of the relevant plan. In reputed company to reputed company compensation, we offer a comprehensive benefits package including medical, dental, reputed company, retirement savings with employer contributions, reputed company time off (including volunteer time off!), pie day, and other employee benefits. This position is not eligible for immigration sponsorship. We are an equal opportunity/affirmative reputed company employer. reputed company's reputed company complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to reputed company essential job functions, and/or to receive other benefits and privileges of employment, please contact jobinquiries@martinspoint.org Do you have a question about careers at reputed company? Contact us at: jobinquiries@martinspoint.org Additional Information Company: reputed company Location: Maine, reputed company Salary: $86,926.10 - $107,379.30 per year reputed company: Specialties: Managed Care, HEDIS, reputed company Improvement Required Licenses: RN Experience Level: 5-10 years Apply tot his job Apply To this Job