HEDIS Abstractor

Role: HEDIS Abstractor supporting Quality Care Improvement initiatives by conducting medical record reviews and abstraction activities to identify and close HEDIS care gaps. Responsibilities Perform chart reviews, abstract clinical data, interpret HEDIS measure specifications, validate data accuracy, and support HEDIS audits. Collaborate with providers, internal teams, and external vendors to obtain documentation and ensure compliance with privacy regulations. Analyze results, identify trends, and recommend process improvements to enhance measure performance. Maintain quality standards, support quality improvement efforts, and assist with reporting activities. Qualifications & Skills High school diploma or equivalent; healthcare-related degree preferred. At least 2 years of HEDIS abstraction or medical record review experience. Proficiency in clinical coding systems (ICD-10, CPT, HCPCS), knowledge of NCQA HEDIS standards, and experience with EMR/EHR systems. Strong analytical, organizational, and communication skills, with attention to detail. Healthcare certifications (e.g., CPC, RHIT, RN) and experience with managed care, CMS Stars, or risk adjustment are advantageous. Additional: Ability to work independently, manage multiple priorities, and travel locally for onsite visits. Hybrid work environment with remote support.