Freshly Licensed PHRN

2 weeks ago

Taguig, National Capital Region, Philippines ATOS Information Technology Inc. Full time ₱900,000 - ₱1,200,000 per year

Shift Schedule: Night shift during training, then mid shift afterward.

Work Setup: Fully onsite during training, then remote afterward.

Qualifications:

  • Registered Nurse (PH RN)
  • Coding certification not required
  • HEDIS experience not required

Essential Duties and Responsibilities:

  • Reviews medical records to abstract data elements required for HEDIS reporting, focusing on both hybrid and administrative measures.
  • Applies knowledge of NCQA HEDIS technical specifications to determine measure compliance and exclusion criteria.
  • Validates relevant ICD-10-CM, CPT, and HCPCS codes to support quality measure documentation.
  • Navigates multiple EMR systems to locate and interpret clinical information (e.g., progress notes, lab results, specialist reports).
  • Ensures abstraction accuracy by adhering to inter-rater reliability standards and internal quality assurance benchmarks.
  • Works closely with QA leads, clinical reviewers, and team leads to resolve discrepancies and clarify guidelines.
  • Participates in pre-season and in-season training sessions to stay current on evolving HEDIS measure specifications.
  • Maintains detailed documentation of abstraction logic and rationale for audit trail and client reference.
  • Contributes to continuous process improvement by identifying documentation gaps, workflow inefficiencies, or system issues.
  • Maintains strict compliance with HIPAA and organizational privacy/security standards when handling patient data.

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