AAPC/AHIMA Certified Professional Coder

Key Responsibilities

• Perform Quality Assurance (QA) on HEDIS measure charts and abstraction results
• Review and validate accuracy, completeness, and compliance of HEDIS data
• Analyze HEDIS measurement specifications and ensure adherence to NCQA guidelines
• Conduct detailed chart reviews to identify gaps, inconsistencies, and coding errors
• Interpret and apply HEDIS technical specifications during QA validation
• Independently research on HEDIS requirements using the NCQA manual
• Collaborate with internal teams to resolve discrepancies and improve data quality
• Provide feedback and recommendations to enhance QA processes and outcomes

Required Qualifications

• AAPC or AHIMA certification (mandatory)
• Proven experience in HEDIS measures and reporting
• Hands-on experience in QA of HEDIS measure results
• Strong understanding of NCQA HEDIS guidelines and specifications
• Ability to independently research and interpret NCQA manual requirements
• Solid knowledge of medical coding standards (ICD-10, CPT, HCPCS)
• Strong analytical skills and attention to detail
• Excellent communication and documentation skills