Responsibilities
- Performing medical record abstraction and overread in support of Quality reporting (annual HEDIS and State EQRO)
- Ensuring the integrity and accuracy of clinical data by performing comprehensive medical record reviews
- Determining compliance with national quality standards and state performance measures
- Managing the medical records identification process, including collection activities, provider outreach (calls/faxes), and chart retrieval requests
- Applying structured auditing criteria to medical records to determine compliance with HEDIS and State Measure Technical Specifications
- Utilizing specialized software applications to accurately enter chart audit results into the database and provide real-time feedback
- Maintaining a minimum 98% abstraction proficiency rate by correctly interpreting various record components such as consultations, medication forms, and health histories
- Developing and maintaining expertise in mandated HEDIS requirements and performing overreads to ensure data quality in a live software environment
- Consistently meeting or exceeding the minimum volume of chases/charts per defined period as required by policy
Requirements
- 3–5 years of HEDIS data experience (chart review/collection)
- Expertise in medical terminology and charting (diabetic labs, HPV testing, preventive screenings, and immunization/well-care terminology)
- Experience with QRS or STARs is highly preferred
- Associate’s Degree, RN, LPN, or equivalent relevant work experience
- Experience with medical record abstraction tools and a willingness to learn new platforms
- Experience in Pediatric, Maternity, Diabetic, or Provider Office settings
- Proficiency in Microsoft Office (Excel, Word, PowerPoint, and Outlook)
- Familiarity with the Cancer Registry and Bright Futures guidelines
- Strong written and oral communication, critical thinking, and organizational skills
- Ability to work independently and effectively under the pressure of strict deadlines
Work Arrangement
Hybrid
Additional Information
- Schedule: 8:00 AM – 5:30 PM EST, Monday – Friday (some weekend work may be required)
