HEDIS Abstractor and Overreader

Essential Job Functions:

• Review and abstract clinical data from electronic medical records in alignment with HEDIS technical specifications
• Perform overreads of abstracted medical records for accuracy, completeness and measure compliance
• Demonstrate high level of proficiency in HEDIS measures and coding standards (including but not limited to ICD-10, CPT and CPTII) to close gaps in care
• Collaborate with internal and external partners to resolve documentation discrepancies and provide recommendations for improvement
• Support audit preparation and participate in internal quality reviews and training sessions
• Manages all activities to meet health plan contractual and reporting timeframes
• Identify trends in abstraction that may impact measure performance or audit readiness and proactively escalate to leadership

Other Job Functions:

• Other duties as assigned.

Required Qualifications:

Minimum Experience

• Minimum of 2 years’ experience working with NCQA HEDIS programs and/or HEDIS abstraction in all measures
• Proficiency in EMR platforms (i.e., Epic, Cerner) and abstraction tools
• Familiarity with Medicare Advantage lines of business and Stars Measures
• Familiarity with supplemental data processes and quality data integration

Education & Licensure

• High School Diploma or equivalent required

Skills and Abilities:

• Ability to be a team player and exercise initiative in responding to team members or Sr. Manager.
• Thorough understanding of medical record documentation and medical terminology
• High level of attention to detail and ability to follow direction on project deadlines
• Ability to work independently
• Strong language skills in English speaking and understanding
• Ability to meet high productivity requirements and Interrater Reliability standards
• Strong Excel skills
• Ability to interpret compliance vs non-compliance on health plan gap file use to direct abstraction efforts.
• Ability to apply deep level of measure understanding to legal medical records
• Strong Adobe skills (including saving records in PDF format and annotation)
• Ability to interpret large data files for needed abstraction
• Deep level of ability to recognize medical records that are not complete or are missing needed data points in overreading
• Ability to report clearly on both positive or negative findings and apply possible solutions on Team calls

Salary range shown is a guideline. Individual compensation packages can vary based on factors unique to each candidate, such as skill set, experience, and qualifications.