[Hiring] Supplemental Data Auditor @Health Care Service Corporation

Role Description

This position is responsible for ensuring the audit and review of electronic clinical records to ensure they accurately reflect medical record documentation to meet regulatory and accrediting compliance mandates. Responsibilities include:

• Oversight and review of the abstraction/extraction process of clinical data from Electronic Medical Records (EMRs).
• Auditing supplemental files supplied by providers and vendors for HEDIS, QRS, and other quality measures.
• Identifying areas of opportunity to improve documentation and audit outcomes.
• Impacting the integrity of the Medical Record validation process and HealthCare Effective Data & Information Set (HEDIS) Reporting.
• Contributing toward the achievement and maintenance of accreditation with national accreditation agencies.

Qualifications

• Bachelor’s degree or higher in a clinically related field.
• Knowledge of Healthcare Effective Data & Information Set (HEDIS) type of reporting and software tools.
• Minimum of 3 years’ Healthcare industry experience; healthcare data.
• Experience with NCQA and HEDIS reporting, technical data analysis in a formal audit environment.
• Understanding of claims, provider, and membership systems, or similar database systems.
• Knowledge of federal and state quality reporting and accreditation regulations for the health insurance industry (URAC, NCQA, ACA, State Depts of Insurance and/or comparable regulatory bodies).
• Written, verbal, and interpersonal communication skills.
• Self-starter with problem-solving abilities.
• PC proficiency to include Word, Excel, PowerPoint.

Requirements

• Registered Nurse (RN) with unrestricted license in state (preferred).
• Clinical quality auditing experience (preferred).
• Proven ability to navigate new systems and technology with minimal impact to daily agenda (preferred).
• Experience with Coding is highly preferred or Certified Coding Certification (preferred).
• Strong Analytical Skills (preferred).
• This role is Telecommute (Remote).

Benefits

• Health and wellness benefits.
• 401(k) savings plan.
• Pension plan.
• Paid time off.
• Paid parental leave.
• Disability insurance.
• Supplemental life insurance.
• Employee assistance program.
• Paid holidays.
• Tuition reimbursement.
• Other incentives.