Current jobs related to HEDIS Data Reviewer - Newtown Square - JobRialto

  • HEDIS Data Reviewer

    4 days ago

    Newtown Square, Pennsylvania, United States Della Infotech Full time

    About the RoleWe are seeking a highly skilled HEDIS Data Reviewer to join our team at Della Infotech. As a key member of our Medical Record Review Operations team, you will play a critical role in supporting our Quality reporting efforts.Key ResponsibilitiesCoordinate medical records identification, collection, and review processesPerform structured auditing...

  • Utilization Review RN

    1 month ago

    Pioneer Square, United States Swedish Health Services Full time

    Description Remote - Utilization Review RN On call/Per diem The Utilization Review (UR) Nurse has a strong clinical background blended with a well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient...

  • Supply Chain Operations Intern

    2 weeks ago

    Newtown Square, Pennsylvania, United States Sunoco GP LLC Full time

    About Sunoco GP LLCSunoco GP LLC is a leading energy infrastructure and fuel distribution master limited partnership operating across the United States, Puerto Rico, Europe, and Mexico. The Partnership's midstream operations include an extensive network of approximately 9,500 miles of pipeline and over 100 terminals. This critical infrastructure complements...

  • Business Development Intern

    2 weeks ago

    Newtown Square, Pennsylvania, United States Sunoco GP LLC Full time

    About Sunoco GP LLCSunoco GP LLC is a leading energy infrastructure and fuel distribution master limited partnership operating across the United States, Puerto Rico, Europe, and Mexico. The Partnership's midstream operations include an extensive network of approximately 9,500 miles of pipeline and over 100 terminals. This critical infrastructure complements...

  • Logistics and Supply Chain Management Intern

    2 weeks ago

    Newtown Square, Pennsylvania, United States Sunoco GP LLC Full time

    About Sunoco GP LLCSunoco GP LLC is a leading energy infrastructure and fuel distribution company operating across the United States, Puerto Rico, Europe, and Mexico. Our midstream operations include an extensive network of approximately 9,500 miles of pipeline and over 100 terminals. This critical infrastructure complements our fuel distribution operations,...

  • Intern - Supply Chain

    2 weeks ago

    Newtown Square, United States Energy Transfer Full time

    Sunoco LP is a leading energy infrastructure and fuel distribution master limited partnership operating across 47 U.S. states, Puerto Rico, Europe, and Mexico. The Partnership's midstream operations include an extensive network of approximately 9,500 miles of pipeline and over 100 terminals. This critical infrastructure complements the Partnership's fuel...

  • Register Behavior Technician

    2 months ago

    Newtown Square, United States US Medical Staffing Inc Full time

    Job DescriptionJob DescriptionUS Medical Staffing is seeking Registered Behavioral Technician - RBT to support children receiving ABA-based services in clinics/classrooms. The BHT will work one-on-one with students aged 3-5, implementing individualized instructional and behavioral strategies. This role is crucial in supporting the direct implementation of...

  • Register Behavior Technician

    3 months ago

    Newtown Square, United States US Medical Staffing Inc Full time

    Job DescriptionJob DescriptionUS Medical Staffing is seeking Registered Behavioral Technician - RBT to support children receiving ABA-based services in clinics/classrooms. The BHT will work one-on-one with students aged 3-5, implementing individualized instructional and behavioral strategies. This role is crucial in supporting the direct implementation of...

  • Orthopedic Coding Specialist

    2 weeks ago

    Newtown Square, Pennsylvania, United States Center for Orthopedic and Research Excel Full time

    Job Title: Orthopedic Coding SpecialistAbout Us:Center for Orthopedic and Research Excel is a leading provider of orthopedic services, dedicated to delivering exceptional patient care and innovative research solutions.Job Summary:We are seeking a highly skilled Orthopedic Coding Specialist to join our team. As a key member of our coding department, you will...

  • Orthopedic Coding Specialist

    2 weeks ago

    Newtown Square, Pennsylvania, United States Center for Orthopedic and Research Excel Full time

    Job Title: Orthopedic Coding SpecialistAbout Us:Center for Orthopedic and Research Excel is a leading provider of orthopedic services, dedicated to delivering exceptional patient care and innovative research solutions.Job Summary:We are seeking an experienced Orthopedic Coding Specialist to join our team. The successful candidate will be responsible for...

  • Patient Care Coordinator

    1 day ago

    Newtown Square, Pennsylvania, United States Optum Full time

    Optum Job OpportunityAt Optum, we're dedicated to delivering care and improving health outcomes for millions of people worldwide. As a Part Time Associate Patient Care Coordinator, Floater, you'll play a vital role in connecting patients with the care, pharmacy benefits, data, and resources they need to thrive.Key Responsibilities:Provide exceptional...

  • Strategic Sourcing Specialist

    3 weeks ago

    newtown square, United States Briarlake Partners Full time

    Briarlake Partners is a strategic sourcing focused recruiting firm. We are working with a Philadelphia based energy company with a few Strategic Sourcing Specialist roles open. We are looking for candidates with experience running RFP/RFQs, demonstrated ability to analyze data and realize savings through RFP and contract execution, contract negotiation...

  • Strategic Sourcing Specialist

    3 weeks ago

    newtown square, United States Briarlake Partners Full time

    Briarlake Partners is a strategic sourcing focused recruiting firm. We are working with a Philadelphia based energy company with a few Strategic Sourcing Specialist roles open. We are looking for candidates with experience running RFP/RFQs, demonstrated ability to analyze data and realize savings through RFP and contract execution, contract negotiation...

  • Strategic Sourcing Specialist

    4 weeks ago

    Newtown Square, United States Briarlake Partners Full time

    Briarlake Partners is a strategic sourcing focused recruiting firm. We are working with a Philadelphia based energy company with a few Strategic Sourcing Specialist roles open. We are looking for candidates with experience running RFP/RFQs, demonstrated ability to analyze data and realize savings through RFP and contract execution, contract negotiation...

  • Strategic Sourcing Specialist

    1 month ago

    Newtown Square, United States Briarlake Partners Full time

    Briarlake Partners is a strategic sourcing focused recruiting firm. We are working with a Philadelphia based energy company with a few Strategic Sourcing Specialist roles open. We are looking for candidates with experience running RFP/RFQs, demonstrated ability to analyze data and realize savings through RFP and contract execution, contract negotiation...

  • Patient Care Coordinator

    1 day ago

    Newtown Square, Pennsylvania, United States Optum Full time

    Optum Job OpportunityAt Optum, we're dedicated to delivering care and improving health outcomes for millions of people worldwide. As a Part Time Associate Patient Care Coordinator, Floater, you'll play a vital role in connecting patients with the care, pharmacy benefits, data, and resources they need to thrive.Key Responsibilities:Provide exceptional...

  • Summer 2025 Intern

    4 weeks ago

    Newtown Square, United States AmeriHealth Caritas Health Plan Full time

    AmeriHealth Caritas Family of Companies offers paid summer internships to students enrolled in full time undergraduate or graduate degree programs.As an AmeriHealth Caritas intern, you will learn about the health care industry, our Medicaid and Medicare plans, pharmacy benefits management and behavioral health care - and how we are working to improve access...

  • Business Technology Platform Senior Customer Success Partner

    6 days ago

    Newtown Square, Pennsylvania, United States SAP Full time

    About the RoleWe are seeking a highly skilled Business Technology Platform Senior Customer Success Partner to join our team. As a key member of our customer success organization, you will be responsible for driving customer value realization and ensuring the successful adoption of SAP Business Technology Platform.Key ResponsibilitiesDevelop and execute...

  • Revenue Cycle Manager

    2 months ago

    Newtown Square, United States Center for Orthopedic and Research Excel Full time

    Job DescriptionJob DescriptionPremier Orthopedics and Sports Medicine is looking for a Revenue Cycle Manager to oversee our CBO located in Newtown Square, PA.The Company: Premier Orthopaedics is a full-service orthopaedic practice formed in 2000 that specializes in the diagnosis and care for a wide range of orthopaedic injuries and conditions. Through...

  • Vice President of Ambulatory Operations

    1 day ago

    Newtown Square, Pennsylvania, United States Main Line Health Full time

    Make a Difference in Ambulatory OperationsAs the Vice President of Ambulatory Operations at Main Line Health, you will play a critical role in ensuring the delivery of high-quality patient care and safe operations across our medical group ambulatory practice sites.Key Responsibilities:Develop and implement strategies to improve quality patient care and...

HEDIS Data Reviewer

4 months ago

Newtown Square, United States JobRialto Full time
Description

Job Summary:

Under the direction of the Manager of Medical Record Review Operations, the HEDIS Data Reviewer is responsible for performing medical record abstraction and overread in support of Quality reporting (annual Healthcare Effectiveness Data and Information Set (HEDIS) and State EQRO) with duties including but not limited to the following:

Coordination of the medical records identification process, collection activities and review.

Performing and applying structured auditing abstraction criteria to medical records to determine compliance.

Utilizing various software applications to support department operations and accurately entering the results of chart audits into the database.

Developing and maintaining expertise in the requirements and parameters of mandated HEDIS and State performance measures.

Completing medical record review abstraction and overread and providing feedback for medical records that do not meet the HEDIS or State Measure Technical Specifications criteria within a live software environment.

Providing clinical and administrative support to providers as directed.

Maintaining productivity level of a minimum of chases/charts per defined period according to policy.

Maintaining an abstraction proficiency rate of 98% by correctly reading, interpreting, and abstracting various components of the medical record such as notes, consultations, medication forms, treatment plans, health history, interval history, and past history.

Assisting in the medical record collection process including making phone calls, sending out faxes/letters or chart retrieval requests to providers as assigned.

Completing additional designated projects assigned and deemed as necessary.

Skills:

Three to five years working with HEDIS data including chart review/collection.

HEDIS, QRS, or STARs experience. Knowledge of medical terminology and basic charting to include diabetic labs, HPV testing, preventive health screenings, immunization and well-care terminology for children, adults and pregnant women.

Understanding of current HEDIS Technical Specifications.

Knowledgeable in the HEDIS audit process (PSV, CSV and MRRV).

Proficiency in Excel, Word, Power Point and Outlook.

Experience with medical record abstraction tool(s) and wiliness to learn any medical record abstraction tool.

Experience in the Pediatric, Maternity, Diabetic or Provider Office Setting.

Familiar with the Cancer Registry.

Familiar with Bright Futures.

Strong written and oral communication skills, critical thinking skills, strong organizational skills.

Able to think and work independently, effectively, and under pressure of deadlines.

Education:

Associates Degree or relevant work experience