LPN/RN Quality Review and Audit Lead Representative - remote

LPN/RN Quality Review and Audit Lead Representative, Work from Home , Anywhere, USA in Nashville, Tennessee

Job Summary:

The HEDIS Abstraction Lead Representative works under the direction of the HEDIS Abstraction Lead within the Cigna Medicare Quality Department. These home-based positions are responsible for working independently to review and abstract pertinent medical record information in accordance with multiple study criteria and in alignment with the HEDIS specifications. The information to be abstracted will be obtained from medical records copied from physician offices/healthcare facilities and sent to CIGNA.

These personnel abstract clinical data into HEDIS nonstandard supplemental sources for HEDIS year round working in partnership with Medicare Quality, Stars, Network Operations. They are also responsible for identifying gaps in documentation to share back to providers and market staff for future improvement of HEDIS rates. During the annual HEDIS Medical Record Review (MRR) project (January-May), they also serve as a member of the HEDIS MRR abstraction/over-read team. Must possess proven ability and prior experience using HEDIS software, abstraction and identifying medical chart opportunities for providers. Demonstrates understanding of HEDIS technical Specifications and ability to apply knowledge in a fast-paced environment.

Additionally, the HEDIS Abstraction Specialist may collaborate with non-clinical personnel regarding collection of medical records from physician offices for additional medical record pursuits or may collect the information themselves. All medical records that are copied or received in the Cigna offices must be kept confidential, in accordance with federal and local requirements, and maintained at the Cigna office. Other duties as assigned to improve HEDIS rates including: gleaning records for additional information, utilization research applying measure probability logic to create additional HEDIS chase pursuits, and HEDIS MRR measure team lead.

Minimum Requirements:

• Current active RN or LPN/LVN license preferred
• Three years’experience with HEDIS MRR or HEDIS abstraction/over-read preferred.
• Experience with data entry and audit.
• Experience with electronic medical records
• Intermediate Level experience working with Microsoft Office Products. (Outlook, Word, Excel,and PowerPoint).

  If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

  About Cigna Healthcare

  Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

  Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

  If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

  The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.