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Strong understanding of healthcare quality measures, including NCQA HEDIS measures, measures derived from EHR and other standardized datasets, administrative data, and public health databases. Manage the process of NCQA certification for HEDIS measures, including data collection, submission, and validation.
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Knowledge of New York State Medicaid and CMS Medicare regulations and related reporting requirements such as STARS, QARR, MMCOR, MEDS, RAPS, EDGE and HEDIS required. Working knowledge of health care EMR or claims systems (Epic/Clarity, eCW, Facets, QNXT, Amisys, etc.
$86,000 - $165,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Good knowledge and working experience on US Health-care Payer E2E Claims Adjudication , Provider Data Management, Member Enrollment, Care Management, HEDIS, Poupulation Health, and Billing. Good knowledge and working experience on US Health-care Payer E2E Claims Adjudication , Provider Data Management, Member Enrollment, Care Management, HEDIS, Poupulation Health, and Billing.
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Implements HEDIS measure campaigns and other quality initiatives as directed by Corporate Health Services to ensure the highest standards of care and to promote the improvement of care management and delivery.
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Demonstrated knowledge of Hedis and QARR quality measures, ICD-9 and CPT coding for reimbursement of services required. Manages and provides clinical services in compliance with standards of Patient Centered Medical Home, meaningful use of medical record data, HEDIS and QARR quality of care measurements.
$58.3 - $77.72 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Market Director also serves as the risk manager for the local market plan and, overall, is responsible for the clinical performance of the market, including HEDIS / Stars ratings, admissions per 1k, documentation and coding accuracy, medication therapy management (MTM) review rates, and more.
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Understanding and ability to explain complex concepts like HEDIS, risk adjustment, quality referrals, data exchange, medical record retrieval, etc. Digital health builders of all sizes, including national health plans, leading Management Services Organizations (MSOs), value-based care enablers, and tech companies, use Vim's platform to connect with over 2,000 care provider organizations giving them the tools and resources they need to operate efficiently and thrive without the burden of portals or spreadsheets.
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The Senior Data Analyst should be familiar with external benchmark sources (i.e., Medicare fee schedules, Milliman data, HEDIS, etc.) Use external benchmark sources (i.e., Medicare fee schedules, Milliman data, HEDIS, etc.
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Ensure all HEDIS (Healthcare Effectiveness Data and Information Set), HCC (Hierarchical Condition Categories) and PCMH (Patient-Centered Medical Home) measures are completed in the required time frame.
$105,000 - $125,000 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Monitors quality metric benchmarks such as HEDIS measures, triple aim initiatives (reduce hospital and ER/ED visits; increase primary care connections) Synthesize data that aggregates quality projects outcomes (chart reviews, incident reports, gaps-in-care, quality scorecards, HEDIS measures, etc.
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The primary function of the Clinical Quality Reviewer is to assess and audit medical charts for compliance with a focus on HEDIS, QARR, Medicare Advantage Star measures and quality improvement activities.
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HEDIS experience strongly preferred. Serves as database administrator and facilitates biannual MCG-IRR testing (Milliman Care Guidelines-Inter Rator Reliability) that is administered to clinical and medical director staff.
$76,800 - $102,795 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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RN/LPN Supplemental Data Collection/HEDIS. Retrieve, review, and abstract medical record data as required for multiple and complex STARS and HEDIS measures. Preferred experience includes HEDIS or supplemental data project abstraction, medical record review, and project participation involving travel.
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Utilize clinical experience, great communication skills, an understanding of medical practice documentation, as well as knowledge of regulatory requirements for community health centers (i.e. CMS, Meaningful Use, UDS, HEDIS, OSHPD etc.
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Optum Senior Community Care provides the Patient Connect Program for United Healthcare members in a short stay/transitional setting with focus on reduction in 30-day hospital readmissions, improved completeness and coding accuracy of diagnosis and medical record documentation, increased closure of STAR/HEDIS quality measures, improved completion rates of Advanced Care Planning Directives, and improved patient and family satisfaction and discharge and post discharge support.
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