Appeals Nurse

Spectraforce Technologies

United States, New York, New York

Oct 24, 2024

Job Title: Appeals Nurse

Job Location: Remote

Job Duration: 5 Months (Potential to Extend)

Responsibilities: Responsibilities include retrieving medical records with clinical accuracy using remote access to Electronic Medical Record Systems while meeting daily productivity expectations. Accuracy and productivity rates are closely monitored to maintain a >95% accuracy rate, but also to be efficient and productive as compared to their peers. Additionally, perform RateMax duties including, but not limited to, medical record review for missed opportunities and provider chase leads, claims research, and chase activation. Complete training and testing in the required timeframe with a satisfactory pass rate. Communicate and collaborate with coworkers, team leads and manager. Follow HIPAA and company guidelines to safeguard PHI and PII Utilize company equipment in a private, secured, at home location using wired cable, fiber, DSL or BPL internet. Additional tasks as delegated by team leads and/or manager. HEDIS remote access EMR retrieval. Staff conduct a detailed review of Electronic Medical Record Systems via remote access logins to locate documentation applicable to HEDIS Hybrid Measures to determine if the quality-of-care measures, as defined by NCQA for that year's HEDIS audit, can be met. Applicable documentation is saved to file using an appropriate file format and electronically uploaded via web browser into the abstraction portal.
Internal/External Groups with which the Candidate will interface:
Required Skills/Experience:		Preferred Skills/ Experience:
1.	Electronic Medical Record (EMR) navigation	1.	HEDIS Project experience
2.	Ability to be productive independently in a remote environment	2.	Experience abstracting data from medical records
3.	Healthcare experience in medical terminology, medical record review, coding, or similar experience	3.	Experience in QSHR or working with copy service vendors
4.	HEDIS knowledge	4.	Ability to adapt to changing priorities in managing a wide range of projects.
5.	Attention to detail	5.	Remote Access EMR record retrieval
Education Requirement:	Associate's degree or relevant 2+ years' medical and HEDIS experience	Education Preferred:	Bachelor's degree RN
Software Skills Required:	Microsoft Suite - Word, Excel, Teams, Outlook, OneNote, and PPT
Required Certifications:		Required Testing:	Testing on HEDIS Measures