Hedis Data Reviewer

6 days ago


Newtown Square, Pennsylvania, United States Della Infotech Full time
Job Title: Hedis Data Reviewer

At Della Infotech, we are seeking a highly skilled Hedis Data Reviewer to join our team. As a Hedis Data Reviewer, you will be responsible for performing medical record abstraction and overread in support of Quality reporting (annual Healthcare Effectiveness Data and Information Set (HEDIS) and State EQRO).

Key Responsibilities:
  • Coordinate the medical records identification process, collection activities, and review.
  • Perform and apply structured auditing abstraction criteria to medical records to determine compliance.
  • Utilize various software applications to support department operations and accurately enter the results of chart audits into the database.
  • Develop and maintain expertise in the requirements and parameters of mandated HEDIS and State performance measures.
  • Complete medical record review abstraction and overread and provide feedback for medical records that do not meet the HEDIS or State Measure Technical Specifications criteria within a live software environment.
  • Provide clinical and administrative support to providers as directed.
  • Maintain productivity level of a minimum of chases/charts per defined period according to policy.
  • Maintain 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.
  • Assist in the medical record collection process including making phone calls, sending out faxes/letters or chart retrieval requests to providers as assigned.
Requirements:
  • 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, PowerPoint, and Outlook.
  • Experience with medical record abstraction tool(s) and willingness 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:

LPN, CNS, APRN, or RN preferred. Medical Record Professionals and Coders with demonstrated expertise in HEDIS abstraction will be considered.

Schedule Notes:

Monday - Friday, 8:30 a.m. - 5 p.m.


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