HEDIS Data Reviewer

1 week ago


Newtown Square, Pennsylvania, United States Della Infotech Full time
HEDIS Data Reviewer Job Summary

We are seeking a highly skilled HEDIS Data Reviewer to join our team at Della Infotech. 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 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 results of chart audits into the database.
  • Develop and maintain expertise in HEDIS and State performance measures requirements and parameters.
  • Complete medical record review abstraction and overread, providing feedback for medical records that do not meet 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 abstraction proficiency rate of 98% by correctly reading, interpreting, and abstracting various components of the medical record.
  • Assist in 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.
  • Understanding of current HEDIS Technical Specifications.
  • Knowledgeable in 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 Pediatric, Maternity, Diabetic, or Provider Office Setting.
  • Familiar with Cancer Registry and Bright Futures.
  • Strong written and oral communication skills, critical thinking skills, and 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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