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Hedis Nurse Resume Samples
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Candidate Info
13
years in workforce
2
years at this job
Nursing
HEDIS Nurse
- Perform accurate HEDIS medical record data abstraction for all measure compliance via Medabstract and Med Capture tool
- Initiate member outreach and survey support, compile information and prepare reports for management, utilize findings and trends to improve efficiency as well as customer satisfaction
- Maintain HIPPA regulations for consumer privacy and complete tasks in a timely manner, ensure compliance with NCQA, federal, state and other regulatory agency standards
- 96% accuracy on medical record review and abstraction
- Over-read 100% of outside vendor abstractions per client protocols
Candidate Info
28
years in workforce
1
year at this job
BS
Nursing
MA
Health Law
HEDIS Nurse
- Functioned as a remote HEDIS nurse and performed medical record analysis using electronic medical records.
- Accomplished numerous tasks including data abstraction from charts of specific indicators, inputted and submitted data via computer program.
- Completed Inter-Rater Reliability reviews for multiple measures to assist team lead in timely project completion.
Candidate Info
31
years in workforce
1
year at this job
HS
Vocational Nursing
BS
Psychology
HEDIS Nurse Abstractor
- Contract position with a major health plan, responsible for the extensive and accurate review of medical records. Abstracted and over-read more than 10,000 charts to validate data accuracy and ensure compliance with HEDIS Technical Specifications while maintaining a less than 1% error rate at all times. Accurate data entry of medical record abstractions into Inovalon Platform.
- Performed year around HEDIS activities including member and provider outreach.
- Identified and educated providers and staff on missing elements in chart documentation. Provided education in regards to the Provider Opportunity Reports and Gaps in Care Lists, contributing feedback on HEDIS scores-to-date and opportunities to improve overall HEDIS rates.
- Reviewed and performed quality checks to prepare medical records for the MRRV process.
- Coordinated retrieval of medical records with provider offices.
- Created and developed HEDIS Tip Sheets for physician practices and hospitals.
- Created and developed work flows and desktop procedures for the schedulers and nurses for electronic medical records collection and abstraction.
- Assisted with preparing and conducting abstractor training for Plan Partners and internal staff.
- Served as a resource and subject matter expert to providers, provider staff, plan partners, IPA's and other departments on HEDIS specifications, coding, documentation and best practices.
Candidate Info
15
years in workforce
4
months at this job
AS
Associate of Science
AA
Associate of Arts
HEDIS Nurse
- Collect data from a variety of electronic (EMR, EPIC) and paper sources.
- Conduct reviews of the data/records to ensure abstraction accuracy of clinical data elements for HEDIS reporting.
- Document findings in HEDIS database tool.
- Meeting and maintaining quality requirement of 98% review accuracy.
Candidate Info
39
years in workforce
10
years at this job
BS
Nursing
Clinical Quality Review Nurse- Hedis Nurse
Contracted with [company name] for Hedis Qarr Project
- On site audit visits at Providers offices reviewing and abstracting medical records pertinent to Hedis Measures
- Data entry into [company name]'s computer software
- Researching claims history and following up on leads to obtain necessary data needed
- Responsible for reviewing and signing off on finished records submitted by other nurses to ensure accuracy and completion
- Weekly team meetings to discuss progress, and overall percentage comparisons on status of project with records collected
- Faxing and calling on non compliant providers requesting specific records.
Candidate Info
7
years in workforce
11
months at this job
AS
Nursing
Certification
Quality Management Associate/hedis Nurse Reviewer (contract)
- Performed medical record audit for EPSDT (Health Check) and Clinical Practice Guidelines reviews for the plans ADHD, Asthma and DM population.
- Generates Corrective Action correspondence to providers, members, and regulatory entities.
- Performing provider/practitioner medical records reviews, abstraction and data entry for HEDIS measures
- Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment.
Candidate Info
8
years in workforce
2
months at this job
AS
Nursing
AA
Associate of Arts
Certificate Lpn
HEDIS Nurse Reviewer
- Conduct chart review for HEDIS measures with managed care plan.
- Schedule onsite visits with provider offices, clinics and other clinical facilities.
- Copy or scan relevant components of the medical record to support reviews performed.
- Document HEDIS measures in Medhok system.
Candidate Info
19
years in workforce
2
months at this job
AS
Medical Billing And Coding
Practical Nursing
Medicare Information Exstractor or HEDIS Nurse Rehired for 03/14 to 05/14
Abstractor
- Abstracts, codes and assigns necessary demographic and clinical data elements required for outpatient records.
- Entering data into using I tool software.
- Reviewing Medicaid, Medicare patient charts for approval through the HEDIS Program.
Candidate Info
11
years in workforce
5
months at this job
C
Certificate
HEDIS Nurse Abstracter
Conduct medical records review appropriately
- Collect and analyze data
- Abstract data from multiple records
- Extract relevant information from medical records
- Multitask and troubleshoot problems
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