Job Description

Below mentioned is the job description for your reference:

Job Title: HEDIS Data Reviewer
Location: Fully Remote
Schedule: Monday - Friday, 8:30 am - 5 pm
Assignment Duration: 3+ Months

Job Summary:

• Under the guidance of the Manager of Medical Record Review Operations, the HEDIS Data Reviewer is responsible for performing medical record abstraction and overreads to support annual Healthcare Effectiveness Data and Information Set (HEDIS) reporting and State EQRO requirements.
• Key responsibilities include coordinating medical record collection, applying structured auditing criteria, and accurately entering audit results to ensure compliance with HEDIS and State performance measures.

Key Responsibilities:

• Coordinate the identification, collection, and review of medical records for HEDIS and State EQRO reporting.
• Apply structured audit criteria to determine compliance, using software to enter chart audit results.
• Develop and maintain expertise in HEDIS and State performance measure requirements.
• Complete medical record abstraction and overread, providing feedback for non-compliant records in a live software environment.
• Support providers with clinical and administrative assistance as directed.
• Achieve productivity goals by completing a defined number of chart reviews within specified timeframes.
• Maintain an abstraction proficiency rate of 98%, accurately interpreting and abstracting medical records.
• Assist with medical record collection by contacting providers, sending faxes/letters, and retrieving charts.
• Complete additional assigned projects as necessary.

Required Skills and Qualifications:

• Experience: 3-5 years of HEDIS data review/collection, with familiarity in charting for diabetic labs, HPV testing, preventive health screenings, immunizations, and well-care.
• Technical Knowledge: Understanding of current HEDIS Technical Specifications and audit processes (PSV, CSV, MRRV).
• Technical Proficiency: Skilled in Excel, Word, PowerPoint, and Outlook.
• Medical Knowledge: Experience with medical record abstraction tools, pediatric, maternity, diabetic, or provider office settings, Cancer Registry, and Bright Futures.
• Other Skills: Strong communication, critical thinking, and organizational skills; able to work independently and meet deadlines.

Education Requirements:

• Associate Degree or relevant experience.

Job Tags

Similar Jobs