Description: REMOTE (WORK from HOME) - HEDIS Abstractor - Medical Assistant
Monday through Friday 8am EST to 4:30pm
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. Local travel may be required. 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.
Medical Terminology, Microsoft Office products familiarity, computer skills, able to work multiple systems at one time on different monitors, high attention to details
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