HEDIS Abstractor

About the Role

A 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 and abstract clinical data.
• Interpret HEDIS measure specifications and validate data accuracy.
• Support HEDIS audits and collaborate with providers, internal teams, and external vendors to obtain documentation.
• Ensure compliance with privacy regulations.
• Analyze results, identify trends, and recommend process improvements to enhance measure performance.
• Maintain quality standards and support quality improvement efforts.
• Assist with reporting activities.

Requirements

• 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.
• Ability to work independently, manage multiple priorities, and travel locally for onsite visits.

Schedule

Hybrid work environment with remote support.