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HEDIS Audit Analyst in Dayton, OH at Alto Health Care Staffing

Date Posted: 3/1/2018

Job Snapshot

  • Employee Type:
  • Location:
    1 Elizabeth Place
    Dayton, OH
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

HEDIS Audit Analyst needed in Dayton, OH for a full time opportunity!

Nature of Work       
  • Handling a high volume of telephonic interaction with provider offices
  • Following up on requested medical records with providers
  • Keeping excellent documentation of research and contact information
  • Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards
  • Review medical records and abstract data for HEDIS and other measure sets in compliance with standards
  • Track and report on issues and outcomes related to abstractions and over-reads
  • Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required
  • 1st shift, 40 hours/week


Job Requirements

Hard Requirements:

  • At least two years of relevant clinical experience involving medical claims experience and  medial record audit experience

  • Previous experience with navigating CPT4 codes and ICD9 and ICD10 DX based on HEDIS technical Specification

  • Multi-Tasking ability

  • Intermediate proficiency in Microsoft Word, Excel

  • Excellent written and oral communications skills

  • Ability to work independently and within a team environment

  • Decision making/problem solving skills

  • Situational awareness

  • Knowledge of Medicaid/Medicare preferred

  • Excellent customer service skills

  • Critical listening and thinking skills

  • Ability to manage and meet workloads and deadlines

Preferred Requirements:

  • Managed Care experience
  • Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards)

  • Proficiency in Microsoft SharePoint

  • Licensed Practical Nurse (LPN) and/or Registered Nurse (RN) license (in any state) , or Associates, or Bachelor’s Degree