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HEDIS Auditor/Reviewer

TotalMed Phoenix, AZ
  • Expired: 26 days ago. Applications are no longer accepted.

This is a temporary position for HEDIS season, scheduled to go from the end of January through May. This position requires that you reside in AZ, CO, OR, WA or Southern CA.

Contractors on this assignment will be working remote and will be expected to travel to different locations (feet on the street). May be required to travel overnight. travel may be expensed, HM will discuss during interviews.

2-3 week training, limited time off, will be discussed during interview.

Mon-Fri- 8-5, for the most part, outside of travel

The purposes of this role include, but are not limited to:
1. Market specific data collection efforts and provider outreach
2. Medical record review for HEDIS® and HEDIS®-like measures
3. Over read of medical records

The candidate must be technically savvy and must be able to work without distraction. This is a high production environment, and candidates must adhere to measured productivity requirements.

• Schedules on-site reviews with provider offices, medical groups, and other clinical facilities
• Travels to medical facilities in specified area of region to complete chart reviews
• Stays overnight when necessary
• Performs provider/practitioner medical record reviews for HEDIS® and HEDIS®-like measures as part of HEDIS® Quality Solution Delivery staff
• Reviews assigned medical records in order to verify clinical data elements for HEDIS® reporting, e.g., results of laboratory tests, verification of hypertension and the most recent blood pressure reading, prenatal and postpartum care services
• Integrates data collected from a variety of electronic and paper sources
• Demonstrates proficiency in Microsoft Office: Outlook, Excel, and Word and similar applications
o Manages various data organized within Excel spreadsheets
• Identifies findings supported by documentation guidelines with high level of accuracy
• Maintains HIPAA standards and confidentiality of protected health information; reports critical incidents immediately.
• Communicates identification of pursuit leads for additional medical records, if needed, to other members of the team
• Attends conference calls as necessary to provide information relating to clinical reviews and compliance
• Successfully completes HEDIS® technical specification training and testing
• Successfully completes HEDIS® software training and uses software correctly
• Is responsible for meeting daily over read production goal
• Performs other duties as assigned

Shift Start/End Time: 8:00am-5:00pm in time zone as appropriate – Flex as necessary after training - Monday – Friday
• Ability to commit to entire January – May assignment with no or minimal absences

Required Qualifications:
• Requires use of personal vehicle
o Valid driver’s license required when personal vehicle use is necessary
• Ability to stay overnight when necessary
• Minimum 1 year healthcare/health plan experience
• Minimum 1 year HEDIS® experience and/or knowledge
• Solid knowledge of managed care requirements related to clinical quality
• Research and detail oriented, excellent proof reading skills
• Excellent time management and prioritization skills
• Designated workplace inside home (virtual)
• Reliable internet connection (virtual)
• Strong communication skills
• Strong proficiency with Microsoft Office applications, including: Word, Excel, Adobe and PowerPoint
• Critical thinking skills
• Results-driven independent worker, and self-starter
Preferred Qualifications:
• Clinical degree highly preferred, including, but not limited to: RN, LVN, LPN
• Current, unrestricted state license in applicable field
• Experience working with HEDIS® software (data entry, reporting)
• Experience in medical record review (vendor or health plan; onsite or fax/mail)
• Experience working in EMR systems


About TotalMed: In the rapidly-changing, highly regulated industry that is healthcare, you need a medical staffing partner who works for you. Enter TotalMed. We’re an award-winning medical staffing agency delivering flexible healthcare staffing solutions no matter how complex your needs. But even more than that, we’re a team who really cares. Our end goal is to achieve quality patient care while enhancing your employee morale. If you’re a healthcare professional in either clinical or non-clinical healthcare, our recruiters can help you navigate the sea of healthcare jobs, uncovering your ideal career path. Or, if you’re faced with open positions and short-staffed projects in either business care or patient care, TotalMed can provide customized medical staffing solutions to fulfill your hiring requirements.


Phoenix, AZ