HEDIS Chart Retrieval Nurse

Key Responsibilities

• Conduct outbound calls to physician offices, hospitals, clinics, and medical records departments to request records required for HEDIS measures.
• Clearly communicate the purpose of each request, required documentation, applicable date ranges, and release-of-information requirements.
• Cook up with provider office staff and medical records departments to determine the appropriate method for securely transmitting records.
• Follow up on outstanding requests to ensure medical records are received within established project timelines.
• Review received documentation for completeness and confirm that requested records have been provided.
• Upload medical records into the health plan’s secure portal or designated chart retrieval platform.
• Maintain accurate documentation of outreach attempts, provider contacts, pending requests, completed retrievals, and follow-up activity.
• Escalate delays, access issues, incomplete records, and other retrieval barriers to the project lead or supervisor.
• Manage an assigned call queue and daily outreach workload to meet productivity and retrieval targets.
• Manage compliance with HIPAA requirements and protect all confidential and protected health information.
• Perform additional project-related duties as assigned.

Qualifications

• Active Registered Nurse (RN) or Licensed Practical Nurse (LPN/LVN) license.
• (Compacted license preferred or PA).
• Minimum of 1 year of clinical, managed care, quality, medical records, or related healthcare experience.
• Prior HEDIS, medical record retrieval, chart review, or chart abstraction experience preferred.
• Working knowledge of medical terminology, clinical documentation, and EMR/EHR systems.
• Familiarity with HEDIS quality measures and healthcare quality reporting preferred.
• Strong telephone communication and provider outreach skills.
• Strong attention to detail and ability to accurately document and track multiple record requests.
• Able to work independently in a remote, deadline-driven environment.