Seasonal HEDIS Reviewer, RI

JR100056 Please email [email protected] if you are a candidate seeking a reasonable accommodation for the application and/or interview process. At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We’re dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer. Why this job matters: Coordinate medical record-related tasks for Healthcare Effectiveness Data Information Set (HEDIS). Perform a variety of assignments to support team members and leaders. Collaborate with team members to ensure that all medical record reviews are accurately completed and meet intended quality measures. What you will do:

• Perform chart audits for medical record review portions of the annual HEDIS audit.
• Participate in training on hybrid HEDIS measures and data documentation systems.
• Coordinate project-related tasks for HEDIS activities across the organization.
• Support HEDIS Manager to ensure all deliverables are accurately completed and meet intended quality.
• Utilize various data and information systems supporting these activities. Work with technical staff on maintenance of data, and the utilization of various systems to maximize the clinical and business benefits of effective information management.
• Assist team with department initiatives and projects.
• Perform other duties as assigned.

What you need to succeed:

• Associate degree; or an equivalent combination of education and applicable work experience
• 2-4 years of experience in conducting medical record review audit
• Extensive knowledge of medical terminology
• Working knowledge of Microsoft Office including Excel, and Word
• Computer proficiency
• Working knowledge of Adobe Acrobat
• Written and verbal communications skills
• Good organization skills
• Time management skills
• Detail oriented
• Ability to research and organize data
• Ability to organize work efficiently to meet established time and quality standards

Extras:

• Nurse license, RN or LPN
• Knowledge of HEDIS
• Proficiency with Microsoft Suite of products; i.e., Word, Excel, PPT, etc
• Experience in the health insurance industry

Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster. Apply tot his job Apply To this Job