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HEDIS Abstractor (RN / LPN)

Company: The Execu-Search Group
Location: Waukesha
Posted on: November 6, 2018

Job Description:

About the Opportunity

A respected managed care company is seeking a Registered or Licensed Practical Nurse (RN / LPN) HEDIS Abstractor to join their team for the 2018-19 HEDIS project. In this role, the HEDIS Abstractor establishes and fosters a healthy working relationship between large physician practices, IPAs, and the managed care company. Apply today!

Company Description

Managed Care Company

Job Description

The HEDIS Abstractor (RN / LPN) will:



  • Abstract medical record information in accordance with HEDIS Specifications
  • Effectively use the Integrated Solutions Tool (Rapid and IS) for receiving assignments, data entry, abstraction and completing chases, as indicated
  • Effectively use/follow correct procedure with regard to the internal claim system

  • Effectively use all external systems and processes specific to region (Immunization registries) as indicated and assigned by Lead
  • Attend regularly scheduled Team Meetings and additional re-trainings as required/ indicated
  • Understand the process of bucket movement between Research, Pursuit, and Abstraction
  • Understand Exclusion Criteria for each measure and apply appropriately
  • Understand Negative Reason Codes (NRC) and appropriately apply the correct code when closing all chases
  • Abstract the correct medical information to fulfill the requirements for each measure
  • Utilize outside systems such as Immunization Registries as assigned by Lead when needed

    Required Skills



    • Active Wisconsin Registered Nurse (RN) or Licensed Practical/Vocational Nurse (LPN/LVN) license

    • 1+ year of relevant work experience in HEDIS, quality improvement, case management, and chart review

    • Previous experience in a managed care setting
    • Competent in using Microsoft Outlook, Excel, and Skype (Calendar, e-mail , etc.)
    • Solid problem-solving and time management skills
    • Exceptional phone etiquette
    • Excellent communication skills (written and verbal)
    • Strong attention to detail
    • Highly organized
    • Able to multitask efficiently and effectively

    • Competent in using Microsoft Outlook, Excel, and Skype (Calendar, e-mail , etc.)

      Keywords: The Execu-Search Group, Waukesha , HEDIS Abstractor (RN / LPN), Healthcare , Waukesha, Wisconsin

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