HEDIS Abstractor - Medical Assistant
The Judge Group Inc.

Location: Austin, TX
Description: REMOTE - HEDIS Abstractor - Medical Assistant

SUMMARY:

• Candidate will work with the HEDIS team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific data base.
• If necessary the medical record review is conducted on site in provider office or hospital institution. This candidate will be required to handle a high volume of telephonic interaction with provider offices.
• Candidates must follow up on requested medical records with providers.
• Must keep excellent documentation of research and contact information.
• Candidate must pass a medical record abstraction test prior to starting actual record reviews.

MAJOR DUTIES AND RESPONSIBILITIES:

• This is a high production environment and candidates must adhere to measured productivity requirements, module testing and at times retesting to meet minimum requirements.
• Sharing of department responsibilities as assigned.
• Must be flexible and willing to develop and share strategies to accomplish goals.
• Required to perform research on internal claims systems.
• Work under the supervision of Anthem internal staff and designated lead in order to achieve goals and keep the project moving.
• Reviews require data analysis and research within the Anthem data systems.
• Candidates must have critical thinking skills as they will conduct research in a thoughtful and methodical search in order to locate specific claim information.
• Research includes all resources provided in order to find best information.
• Examples of deep dive research would be based on Anthem specific platforms (i.e. Immunization registries, local claims system membership and defaulted claim information).
• Candidates must have excellent skill set to read and interpret physician handwriting.
• Candidates must live within an acceptable commuting distance and reliable transportation is required. Work attire is professional casual.

EDUCATION AND EXPERIENCE:

• Requires a Medical Assistant certification with an AS (Associate in Science) degree and/or has worked as office manager/ admin to a medical office and or assistant to physician and nurses in reviewing of medical records, applying codes for billing/claims, processing files and submitting to insurance or other requested agencies.
• Must understand medical terminology.
• Works under the direction of a HEDIS Lead as a crossover position from abstractor to researcher. Candidates must have prior experience with research and either HEDIS measures or auditing data submitted as claims.
• Candidates must have computer skills and analysis capabilities in order to navigate CPT4 code and ICD9 and ICD10 DX based on HEDIS Technical Specification requirements.
• Candidates must have an understanding of codes for services based on diagnosis and procedure. They must be research and detail oriented with the tenacity to find claim specific data for a specific measure within a given period of time. Knowledge of Microsoft office is required.
• Requires effective written, oral, and interpersonal communication skills.
• Candidates must have basic Excel skills and must have the ability to type 30-40 WPM.
• Prior HEDIS experience a plus.

Contact: mmabry@judge.com

This job and many more are available through The Judge Group. Find us on the web at www.judge.com

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