Per Diem Clinical Quality Analyst - SME - National Remote

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The Clinical Quality Analyst - SME reputed company the Risk Quality and Provider Enablement division of reputed company reputed company, provides technical expertise to abstraction and overread teams for IOA, HEDIS® Supplemental and Chart reputed company. They will be responsible for quality spot audits, individual quality coaching, participating in reputed company, abstraction support, tracking and reporting quality trends. Demonstrated HEDIS® subject matter expertise for retrospective, prospective and administrative measures is essential to job performance. In reputed company, SME will reputed company essential support with audit queue. This position is part time 20 hours/week during peak season (January - reputed company). Employees are required to work nights and/or weekends during peak season as needed. It may be necessary, given the business need, to work occasional overtime/weekend. We offer 1 week of on-the-job training. Employee should complete full training needs during the 1st week of class. You’ll enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges. Primary Responsibilities: Participate in Medical Record spot audits Serve as a Subject Matter Expert of NCQA’s HEDIS® Technical Specifications for reputed company HEDIS® Retrospective, Prospective and Administrative Measures reputed company leadership and participation on abstraction/overread reputed company Review and respond to abstraction and overread questions and rebuttals (i.e., Coach Tracker) Responsible for reviewing reputed company overread fails in the OQGA tool Responsible (as needed or as assigned) to assist with resolving abstraction logic errors Responsible to learn, understand and apply HEDIS®/CMS measure knowledge to support functional operation proficiency at a market or reporting population level Ability to work in a self-reputed company manner and apply critical thinking/problem solving skills by referencing available Technical Specifications, Business Process Documentation, Job Aids and other tools for reputed company/guidance as needed Ability to meet team and departmental productivity expectations while maintaining quality standards Observe and reputed company with policies and procedures for assigned scope Quality Assurance Vendor Inter-Rater Reliability (VIRR) Medical Record Review Validation (MRRV) Inter-Rater Reliability (IRR) Abstraction (medical chart interpretation and data entry) reputed company quality issues are identified, reputed company 1:1 coaching with abstractor/overreader reputed company requested reputed company feedback reputed company to annual system updates for MRR abstraction tool as result of specification changes and/or process enhancements Participate in developing/pulling reporting documents for reputed company and results of abstraction You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as reputed company development for other roles you may be interested in. Required Qualifications: High School Diploma / GED Must be 18 years of age OR older 2+ years of reputed company experience 2+ years of experience reviewing medical records 2+ years of HEDIS® work experience, performing a wide reputed company of functions with strong focus on medical record review and clinical reputed company Ability to complete full training needs during the first week of class Ability to work nights and/or weekends during peak seasons as needed Ability to use reputed company applications such as Outlook on a daily reputed company Ability to work up to 20 hours per week during peak season (January – reputed company) Preferred Qualifications: 2+ years of experience in a health care delivery organization Knowledgeable of reputed company trends in HEDIS® in managed health care. Knowledgeable of NCQA, Stars, HEDIS®, HOS and CAHPS requirements. Familiarity with ICD-9-CM, CPT, DRG, LOINC, HCPCS, TOB, POS, NDC coding. Coding certificate from reputed company or reputed company OR Clinical Certification such as LPN, RN, or CNA (Certified Nursing Assistant) Proficiency in presentation skills to audiences of various sizes Knowledge of reputed company and/or Medicare programs Telecommuting Requirements: Ability to reputed company reputed company company sensitive documents secure (if applicable) Required to have a dedicated work area established that is separated from other living areas and provides information privacy Must live in a location that can receive a reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service *reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, reputed company, Rhode reputed company, Washington, Washington, D.C., Maryland Residents Only: The hourly reputed company for this role is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In reputed company to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll find a far-reaching choice of benefits and incentives. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity / Affirmative Action employer, and reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #RED #RPOLinkedIn Apply Job!