Clinical HEDIS Manager

Clinical HEDIS Manager
Remote

Reveleer is a healthcare data and analytics company that uses Artificial Intelligence to give health plans across all business lines greater control over their Quality Improvement, Risk Adjustment, and Member Management programs. With one transformative solution, the Reveleer platform enables plans to independently execute and manage every aspect of enrollment, provider outreach and data retrieval, coding, abstraction, reporting, and submissions. Leveraging proprietary technology, robust data sets, and subject matter expertise, Reveleer provides complete record retrieval and review services so health plans can confidently plan and execute risk, quality, and member management programs to deliver more value and improved outcomes.

We are seeking a full time HEDIS Manager to oversee duties of HEDIS abstracting and reporting. This role will also manage RISK projects when needed.

WHAT YOU’LL DO:

• Oversee and/or perform an accurate medical record review for all HEDIS measures
• Support and participate in process and quality improvement initiatives
• Conduct training related to HEDIS measures, platform usage, up date any training materials, and function as HEDIS SME
• Monitor project status
• Work on flexible projects with variable client/project specific guidelines
• Review and facilitate IRR review
• Review all Negative / Positive hits
• Manage RISK coding projects when needed- including project status and completing chart reviews for coding projects as needed.

JOB REQUIREMENTS:

• Must have a professional coding certificate through AHIMA/AAPC
• A valid nursing license (RN/LPN) preferred
• Minimum of 5 years of hands-on medical records experience
• 5 Years of HEDIS experience
• Knowledge of NCQA HEDIS abstracting guidelines is a HUGE plus
• Background in UR, QA and/or QI experience preferred
• Strong computer skills and high-speed internet access at home
• Commitment to confidentiality of patient health information
• Professional, articulate and able to work independently
• Ability to manage teams and meet deadlines
• Be able to conduct trainings in nonstandard time frames to meet abstractor needs and training
• Clinical Documentation Review: Analyze medical records and NLP results and validate that the clinical evidence meets the necessary requirements for submission and documentation. This includes making sure the documentation accurately reflects the patient’s conditions, treatment and services provided. Identify gaps, inconsistencies, and discrepancies in documentation that could impact patient care, quality reporting and reimbursement.
• Coding Support: Ensure documentation aligns with accurate code assignment and follow CMS’s coding guidelines for HCC risk adjustment coding.
• Clinical Knowledge: Maintain a deep understanding of medical terminology, disease processes, treatments, and procedures to accurately interpret and validate clinical documentation.
• Documentation Integrity: Safeguard the integrity and confidentiality of patient health information while handling medical records and sensitive data in accordance with HIPAA and other relevant regulations.
• Interdisciplinary Communication: Foster clear communication and collaboration between different healthcare departments, ensuring that accurate patient information is shared across the continuum.

CORE COMPETENCIES

• Caring – Warm, sincere, calm, cool and collected energy and presence with the ability to develop relationships.
• Results Driven – Focus on achievement, motivated by results and outcomes, goal oriented.
• Analytical Skills and Attention to Detail– Reviewing clinical documentation and coding.
• Effectively Communicates – Speaks clearly, listens effectively, and responds well to questions; Writes clearly and informatively; Edits work for errors; Varies writing style to meet needs; Able to read and interpret information; Documents are accurate and delivered on time; Uses good judgement when communicating information.
• Problem Solver - Expertise managing client relationships and accounts for technically complex products and platforms with the ability to lead a resolution towards mutual success.
• Continuous Quality Improvement – Evaluates polices, programs, and services; Implements strategies for continuous quality improvement; Assesses the use of evaluation findings for improving policies, programs, and services; Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
• Customer Focus - Follows through; Courteous; Helps internal and external customers; Understands customer perspectives and needs; Assesses the effects of decisions on different customers and services ; Facilitates collaborations among teams and the customer; Develops and maintains partnerships that will increase customer satisfaction and decrease risk
• Interpersonal Skills - Builds strong relationships; Flexible and open minded; Receptive to feedback; Motivates employees and peers for the purpose of achieving organizational goals.
• Professionalism – Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
• Adaptability – Adapts to changes in the work environment; Adjusts methods to best fit the situation; Able to deal with change, delays, or unexpected events. Can work with diverse groups of customers and internal stakeholders.
• Cultural Sensitivity – Models behaviors that reflect the culture of Reveleer; Awareness of the similarities and differences that exist between employees, teams, departments and customers to build more effective relationships

SALARY RANGE: $100,000 - $115,000 / annually

Our compensation reflects the cost of labor across several US geographic markets. Pay is based on several factors including market location and may vary depending on job-related knowledge, skills, and experience.

Reveleer E-Verifies all new hires.

Reveleer is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, gender identity, sexual orientation, age, marital status, veteran status, disability status or genetic information, in compliance with applicable federal, state and local law.