Job Description

Job Title: HEDIS Data Reviewer

Location: Philadelphia PA

Duration: 3+ Months

Job Type: Contract

Note : Top 3 Keywords: 1- HEDIS Medical Record Abstraction 2- HEDIS Audit Process (PSV/CSV/MRRV) 3- Quality Reporting (HEDIS/QRS/STARs)

Top Required Skills:

• HEDIS Medical Record Abstraction
• Quality Measure Compliance & Auditing
• Medical Terminology & Chart Review

Must-Have Skills:

• 3 5 years of experience with HEDIS data, chart review, and medical record abstraction
• Strong understanding of current HEDIS Technical Specifications
• Knowledge of HEDIS audit processes (PSV, CSV, MRRV)
• Proficiency in medical terminology including preventive screenings, immunizations, diabetic labs, HPV testing, maternity and pediatric care
• Experience using medical record abstraction tools
• Proficiency in Microsoft Excel, Word, PowerPoint, and Outlook
• Ability to accurately interpret and abstract clinical documentation
• Strong written and verbal communication skills
• Ability to work independently and meet productivity and accuracy benchmarks

Nice-to-Have Skills:

• Experience with QRS or STARs quality programs
• Background in pediatric, maternity, diabetic, or provider office settings
• Familiarity with Cancer Registry
• Familiarity with Bright Futures guidelines
• Experience supporting providers clinically or administratively

Key Responsibilities & Duties:

• Perform medical record abstraction and overread to support HEDIS and State EQRO quality reporting
• Apply structured auditing criteria to determine compliance with HEDIS and State performance measures
• Enter chart audit results accurately into designated software systems
• Maintain expertise in HEDIS and State technical specifications and reporting requirements
• Provide feedback on records that do not meet HEDIS or State criteria
• Assist with medical record collection, including provider outreach via phone, fax, and written requests

Requirements:

• Associate's degree, RN, LPN, or equivalent relevant work experience
• Minimum 3 5 years of HEDIS chart review and abstraction experience
• Ability to maintain a minimum productivity level per defined policy
• Ability to achieve and maintain a 98% abstraction accuracy rate
• Ability to work under deadlines and pressure while maintaining quality standards

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