The Nurse Auditor will actively participate in the Risk Adjustment and HEDIS projects for the organization as a nurse auditor. Assist team with data analytics to assure accurate and complete quantitative analysis of HEDIS and Risk Adjustment data. Be familiar with and act as a resource for the organization regarding NCQA HEDIS and CMS QHP Measures Technical specifications; along with Risk Adjustment, including RADV. Collaborates with teams regarding workflow process improvement, document management, and abstraction education as it relates to HEDIS/Risk Adjustment projects. Responsibilities include monitoring, tracking, trending, analyzing, and reporting all data, performance measures, and other required information requested by the Health and Human Services Commission (HHS
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