This role is responsible for supporting the full lifecycle of HEDIS data collection and medical record review in a remote setting. The specialist will coordinate the identification and retrieval of clinical documentation from provider offices, ensuring timely submission for abstraction. Fluency in both English and Spanish is required to accurately interpret and process medical records across diverse sources.
Key Responsibilities
- Manage the collection, review, and abstraction of medical records in alignment with HEDIS specifications
- Collaborate with vendors and internal teams to streamline record acquisition and data entry processes
- Conduct ongoing evaluations of submitted records to verify completeness and accuracy
- Participate in Inter-Rater Reliability (IRR) assessments to maintain consistency in data abstraction
- Load and validate clinical data within the MHI HEDIS application
- Support the HEDIS Program Manager in vendor oversight and staff training initiatives
- Attend regular coordination meetings with corporate teams, auditors, and external partners
- Identify gaps in member care based on data trends and support follow-up interventions
- Assist with quality improvement projects, accreditation readiness, and regulatory audits
Qualifications
Candidates must demonstrate strong written and reading proficiency in both Spanish and English, with the ability to interpret clinical documentation accurately. Experience with medical records and health plan quality reporting is required. Familiarity with HEDIS protocols and data management systems, particularly the MHI HEDIS application, is essential for success in this role.
