HEDIS Data Reviewer

TITLE: HEDIS Data Reviewer

TYPE: Contract

LOCATION: Broomall, PA

ONSITE/REMOTE/HYBRID: Onsite

START DATE: December 2024

SHIFT: Monday - Friday, 8:30 am - 5 pm

We are looking for a HEDIS Data Reviewer. The HEDIS Data Reviewer plays a crucial role under the supervision of the Manager of Medical Record Review Operations. This position is focused on conducting medical record abstraction and comprehensive review for quality reporting, specifically related to the annual Healthcare Effectiveness Data and Information Set (HEDIS) and State EQRO initiatives.

Main Responsibilities

• Apply structured audit abstraction criteria to medical records to assess compliance.
• Coordinate the identification, collection, and review of medical records.
• Stay updated on HEDIS and State performance measure requirements and parameters.
• Conduct medical record abstraction and overread, providing feedback on records that do not align with HEDIS or State Measure Technical Specifications within a live software environment.
• Utilize various software applications to ensure accurate data entry of chart audit results.
• Offer clinical and administrative support to healthcare providers when required.
• Assist with the medical record collection process, including making phone calls and sending faxes or letters to providers as needed.
• Maintain productivity by adhering to the defined minimum of cases/charts reviewed within specified timeframes.
• Achieve a proficiency rate of 98% in abstracting and interpreting various medical record components, including notes, consultations, treatment plans, and patient histories.
• Complete additional assigned projects as necessary.
  
  

Qualifications

• Associate's Degree or equivalent relevant experience.
• Three to five years of experience working with HEDIS data, including chart review and collection. Experience with HEDIS, QRS, or STARs is preferred.
• Thorough understanding of current HEDIS Technical Specifications and the HEDIS audit process (PSV, CSV, and MRRV).
• Proficient in Microsoft Excel, Word, PowerPoint, and Outlook.
• Knowledge of Cancer Registry and Bright Futures guidelines.
• Familiarity with medical terminology and basic charting, particularly concerning diabetic labs, HPV testing, preventive health screenings, immunizations, and well-care for various populations, including children and pregnant women.
• Experience with medical record abstraction tools and a willingness to learn new tools as needed.
• Background in Pediatric, Maternity, Diabetic, or Provider Office settings is a plus.
• Capable of working independently and effectively, even under tight deadlines.
• Strong written and verbal communication skills, along with critical thinking and organizational abilities.
  
  

EOE STATEMENT

We are an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law.