The primary function of the HEDIS Quality Clinical Nurse Auditor is to assess and audit medical record charts for HEDIS/QARR compliance documentation and provider incentive auditing.
- conducting on and off-site audit survey for collection of Health Plan Employer and Data information Set and Quality Assurance Reporting Req ( HEDIS & QARR) audit.
- Ensure data integrity of all individually performed clinical audits, which have been performed and proprietary requirements of assigned activites
-Project professional and customer focused attitude in interaction
- Maintain provider and member confidentiality by ensuring compliance with HIPAA, HIP, regulatory and accreditation confidentiality policies and procedures.
Knowledge Skills & Abilities:
- Excellent assessment skills for medical record review
-strong interpersonal and organizational skills
-ability to meet strict deadlines
-ability to travel to various location to conduct on-site audits
-Valid and current nursing ( LPN) , (RN) or medical record degree is requiered
-minimum of 2-5 years clinical chart auditing experience
-working knowledge of MW and EXCEL
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