HEDIS Data Reviewer

Ideal Candidate Profile • The ideal candidate is an experienced professional with a strong background in HEDIS abstraction and audit processes. • They are adept at medical record review, demonstrate proficiency in Microsoft Office Suite, and possess excellent organizational and communication skills. • Candidates with a clinical background and familiarity with Pediatrics, Maternity, or Diabetic care are highly desirable. Job Description: HEDIS Data Reviewer • The HEDIS Data Reviewer, under the direction of the Manager of Medical Record Review Operations, will oversee and conduct medical record abstraction and overread activities to support Quality reporting initiatives, including HEDIS and State EQRO performance measures. • This role involves reviewing medical records for compliance, utilizing specialized software, and maintaining a high level of accuracy and efficiency. Responsibilities • Coordinate the identification, collection, and review of medical records for HEDIS and State performance measures. • Apply structured auditing and abstraction criteria to medical records to evaluate compliance. • Utilize software applications to accurately enter chart audit results into databases. • Maintain expertise in HEDIS Technical Specifications and State Measure requirements. • Perform medical record review abstraction and overread with a 98% proficiency rate. • Communicate effectively with providers to assist with the medical record collection process, including making calls, sending faxes/letters, and coordinating retrieval requests. • Maintain productivity standards as defined by policy. • Provide clinical and administrative support to providers as required. • Support additional assigned projects and ensure timely completion. Required Skills • Minimum of 3 5 years of experience working with HEDIS data, including chart review and collection. • Proficiency in medical terminology, including diabetic labs, HPV testing, preventive screenings, immunizations, and well-care terminology. • Knowledge of current HEDIS Technical Specifications, audit processes (PSV, CSV, MRRV), and chart abstraction tools. • Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint, and Outlook). • Strong organizational, critical thinking, and communication skills. • Ability to work independently and meet deadlines under pressure. Preferred Experience • Background in Pediatric, Maternity, Diabetic, or Provider Office settings. • Familiarity with Cancer Registry and Bright Futures. Education and Certifications • LPN, CNS, APRN, or RN preferred. • Consideration will be given to Medical Record Professionals and Coders with expertise in HEDIS abstraction. • Proficiency in medical terminology is required. Apply Job!