HEDIS Abstractor - Nurse at The Judge Group Inc. in Philadelphia, Pennsylvania

Job Description:

Location: REMOTE

Salary: $34.00 USD Hourly - $36.00 USD Hourly

Description: The Judge Group is currently looking for HEDIS Nurse Abstractors to work REMOTE!

Job Summary:



Join our HEDIS team to collect and review member records by contacting providers and entering results into a database. This role involves high-volume telephonic interactions with provider offices, following up on requested medical records, and maintaining excellent documentation of research and contact information. Candidates must pass a medical record abstraction test before starting actual record reviews.



Major Duties and Responsibilities:

• Adhere to productivity requirements in a high-production environment.


• Perform research on internal claims systems.


• Develop and share strategies to achieve goals under the supervision of internal staff and designated leads.


• Conduct data analysis and research within data systems.


• Read and interpret physician handwriting accurately.


• Maintain professional casual work attire.


• Utilize critical thinking skills for methodical research to locate specific claim information.


• Conduct deep dive research using Anthem-specific platforms (e.g., immunization registries, local claims system membership, and defaulted claim information).

Education and Experience:

• Licensed nurse (RN, LPN, LVN) with a degree from an accredited nursing school.


• Proficient in computer skills and analysis, including navigating CPT4 codes and ICD9/ICD10 DX based on HEDIS Technical Specifications.


• Understanding of service codes based on diagnosis and procedure.


• Detail-oriented with strong research skills and tenacity to find claim-specific data within a given timeframe.


• Proficient in Microsoft Office, with basic Excel skills and the ability to type 30-40 WPM.


• Effective written, oral, and interpersonal communication skills.


• Prior HEDIS experience is a plus.

If this sounds like something you'd be interested in, please reply with updated resume!


Christina Head, Sr. Healthcare Recruiter


chead@judge.com



Contact: chead@judge.com


This job and many more are available through The Judge Group. Find us on the web at www.judge.com Apply Now