Description:

Candidate will work with the HEDIS team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific data base.

This candidate will be required to handle a high volume of telephonic interaction with provider offices.

Required to perform research on internal claims systems.

Must be flexible and willing to develop and share strategies to accomplish goals. Work under the supervision of internal staff and designated lead in order to achieve goals and keep the project moving.

Reviews require data analysis and research within the data systems.

Candidates must have excellent skill set to read and interpret physician handwriting.

Candidates must have critical thinking skills as they will conduct research in a thoughtful and methodical search in order to locate specific claim information.

Research includes all resources provided in order to find best information.

Examples of deep dive research would be based on specific platforms (i.e. Immunization registries, local claims system membership and defaulted claim information).

CANDIDATE MUST LIVE IN ONE OF THE BELOW CITIES TO BE CONSIDERED:

Altamonte Springs, Florida

Apollo Beach, Florida

Apopka, Florida

Atlantis, Florida

Auburndale, Florida

Ave Maria, Florida

Aventura, Florida

Bartow, Florida

Belle Isle, Florida

Boca Raton, Florida

Boynton Beach, Florida

Boyton Beach, Florida

Bradenton, Florida

Bradley, Florida

Brandon, Florida

Brooksville, Florida

Casselberry, Florida

Celebration, Florida

Champions Gate, Florida

Circle Riverview, Florida

Clearwater, Florida

Clermont, Florida

Cocoa Beach, Florida

Cocoa, Florida

Coconut Creek, Florida

Coconut Grove, Florida

Cooper City, Florida

Coral Gables, Florida

Coral Springs, Florida

Court, Florida

Crystal Beach, Florida

Cutler Bay, Florida

Dade City, Florida

Dania Beach, Florida

Davenport, Florida

Davie, Florida

Daytona Beach, Florida

Debary, Florida

Deerfield Beach, Florida

Deland, Florida

Delray Beach, Florida

Deltona, Florida

Doral, Florida

Dover, Florida

Dunedin, Florida

Ellington, Florida

El Portal, Florida

Estero, Florida

Eustis, Florida

Fleming Island, Florida

Fort Lauderdale, Florida

Gibsonton, Florida

Gotha, Florida

Green Cove Springs, Florida

Greenacres, Florida

Groveland, Florida

Gulfport, Florida

Haines City, Florida

Hallandale Beach, Florida

Hallandale, Florida

Hialeah Gardens, Florida

Hialeah, Florida

Holiday, Florida

Hollywood, Florida

Homestead, Florida

Hudson, Florida

Indian Harbour Beach, Florida

Indian Rocks Beach, Florida

Jupiter, Florida

Key Biscayne, Florida

Kissimmee, Florida

Labelle, Florida

Lady Lake, Florida

Lake Alfred, Florida

Lake Clarke Shores, Florida

Lake Marky, Florida

Lake Mary, Florida

Lake Worth, Florida

Lakeland, Florida

Land O' Lakes, Florida

Lantana, Florida

Largo, Florida

Lauderdale by the Sea, Florida

Lauderdale Lakes, Florida

Lauderhill, Florida

Lighthouse Point, Florida

Lithia, Florida

Longwood, Florida

Loughman, Florida

Lutz, Florida

Madeira Beach, Florida

Maitland, Florida

Mango, Florida

Marco Island, Florida

Margate, Florida

Miami Beach, Florida

Miami Gardens, Florida

Miami Lakes, Florida

Miami Springs, Florida

Miami, Florida

Middleburg, Florida

Minneola, Florida

Miramar, Florida

Montverde, Florida

Moore Haven, Florida

Mount Dora, Florida

Mount Plymouth, Florida

Mulberry, Florida

Naples, Florida

New Port Richey, Florida

New Smyrna Beach, Florida

Newport Richey, Florida

Nokomis, Florida

North Bay Village, Florida

North Lauderdale, Florida

North Miami Beach, Florida

North Miami, Florida

North Miami, Florida

North Palm Beach, Florida

North Seminole, Florida

Oakland Park, Florida

Oakland, Florida

Ocoee, Florida

Odessa, Florida

Oldsmar, Florida

Opa Locka, Florida

Orange Park, Florida

Orlando, Florida

Oviedo, Florida

Palm Beach Gardens, Florida

Palm Beach, Florida

Palm Harbor, Florida

Palm Springs, Florida

Palmetto Bay, Florida

Palmetto, Florida

Parkland, Florida

Parrish, Florida

Pembroke Park, Florida

Pembroke Pines, Florida

Pinellas Park, Florida

Plant City, Florida

Plantation, Florida

Poinciana, Florida

Pompano Beach, Florida

Port Richey, Florida

Princeton, Florida

Redington Beach, Florida

Riverview, Florida

Riviera Beach, Florida

Royal Palm Beach, Florida

Ruskin, Florida

Safety Harbor

Saint Johns, Florida

Saint Petersburg, Florida

San Antonio, Florida

Sanford, Florida

Seffner, Florida

Seminole, Florida

South Pasadena, Florida

Spring Hill, Florida

St Cloud, Florida

St Pete Beach, Florida

St. Cloud, Florida

St. Petersburg, Florida

Sun City Center, Florida

Sun City, Florida

Sunny Isles Beach, Florida

Sunrise, Florida

Tamarac, Florida

Tampa, Florida

Tarpon Springs, Florida

Temple Terrace, Florida

Tequesta, Florida

Thonotosassa, Florida

Titusville, Florida

Treasure Island, Florida

Trinity, Florida

Valrico, Florida

Virginia Gardens, Florida

Wellington, Florida

Wesley Chapel, Florida

West Palm Beach, Florida

Westlake, Florida

Westley Chapel, Florida

Weston, Florida

Wilton Manors, Florida

Wimauma, Florida

Windermere, Florida

Winter Garden, Florida

Winter Haven, Florida

Winter Park, Florida

Winter Springs, Florida

Winterhaven, Florida

Zephryhills, Florida

Skills:

LPN, HEDIS, chart review, LVN, ICD9, ICD10, CPT, Coding, QSHR, Reveleer, Cotiviti, Rapid, M360, Facets, LabCorp, Quest, Medicaid, RN, overread, clinical review

Additional Skills & Qualifications:

Required:

A licensed nurse (RN, LPN, LVN)

Licensed professional graduate of an accredited school of nursing (Associates)

Analysis skills

Prior knowledge of codes used to services based on diagnosis and procedure

Research-oriented

Detail-oriented

Tenacious

Type 30+ WPM

Effective written/oral/interpersonal communications

Knowledge of Microsoft Office (Excel)

Live in the state of FL as local travel/team meetings may be required

Preferred:

Prior HEDIS experience a plus

Experience Level:

Entry Level

About Actalent:

Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We’re supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.