G-TECH Jobs

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G-TECH Services, Inc. Coder Auditor in Detroit, Michigan

Engagement Description – Grand Rapids telecommute

This project will involve participating in provider visits to provide training, education, and review of medical records as well as other requests that to encompass a variety of corporate initiatives. The nurses will be expected to participate in provider and hospital visits to educate, train and review medical records to determine the following:

  1. Verify and help providers close treatment opportunities (HEDIS/Stars measures)

  2. Train provider staff on the use of Health e-Blue (HeB) and coding to close HEDIS gaps

  3. Perform clinical reviews with knowledge of clinical documentation, body systems, anatomy and physiology

  4. Scan records as required

  5. Generate summary of activity monthly and as requested

  6. Develop and maintain an effective professional working relationship with providers and their staff

  7. Contact or answer questions (educate) for Reach out to instate and outstate providers to provide education or respond to inquiries

In addition, contractors may be asked to work on cases involving:

  1. Appropriateness of documentation for select conditions

  2. Physician signature requirements are met (CMS guidelines)

  3. Patient identification documented in the medical records

  4. Assist other departments, consultants when visiting providers to discuss a variety of HEDIS/Stars related issues not limited to high risk medications for example

  5. Conduct other activities as assigned which may include other initiatives beside RMRA and Stars such as in-home Bone Mineral Density (BMD) testing on members

Top 3 Required Skills/Experience –

• Knowledge of NCQA or HEDIS specifications

• Knowledge of Quality Improvement / Process Improvement / Clinical Guidelines

• Experience with Excel is a plus

Required Skills/Experience – The rest of the required skills/experience. Include:

• MUST have a valid RN license!!!

• RN with HEDIS experience but will interview qualified RNs. RNs with certified professional coding experience is a plus.

• Valid MI driver’s license; willing to drive to provider locations and travel throughout Michigan as needed (no exceptions)

• Have a dependable vehicle every workday and be willing to travel five days a week and stay overnight when appropriate

Preferred Skills/Experience – Optional but preferred skills/experience. Include:

• Effective communication skills, written and verbal

• Working knowledge of CMS requirements and NCQA HEDIS measures

• Excellent analytical and problem-solving skills

• Audit and medical chart review experience preferred

• Excellent interpersonal skills necessary to interact with all levels of personnel

• Working knowledge of HEDIS measures and NCQA requirements a plus

• Valid MI driver’s license; willing to drive to provider locations and travel throughout Michigan as needed (no exceptions)

• Have a dependable vehicle every workday and be willing to travel five days a week and stay overnight when appropriate

Education/Certifications – Include:

• R.N. licensed in Michigan; BSN degree preferred; minimum Associate degree acceptable with a minimum 5 years professional experience, (preferably with at least 2 years in adult medicine or community health)

Category Analyst

Function Information Technology

Req ID JN -052022-117869

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