Job Description

Job Description

Job Description

Job Title: HEDIS Data Reviewer

Location: Philadelphia, PA 19113

Duration: 3+ Months

Job Type: W2 Contract

Overview

The HEDIS Data Reviewer will support HEDIS and State EQRO quality reporting through accurate medical record abstraction, auditing, and chart review. This role requires strong knowledge of HEDIS technical specifications, audit processes, and clinical documentation interpretation.

Top Keywords

• HEDIS Medical Record Abstraction
• HEDIS Audit Process (PSV / CSV / MRRV)
• Quality Reporting (HEDIS / QRS / STARs)

Key Responsibilities

• Perform medical record abstraction and over-reads to support HEDIS and State EQRO quality reporting
• Apply structured auditing criteria to assess compliance with HEDIS and State performance measures
• Accurately enter chart audit results into designated abstraction and reporting systems
• Maintain up-to-date knowledge of HEDIS and State technical specifications and reporting requirements
• Provide feedback on medical records that do not meet HEDIS or State criteria
• Assist with medical record collection, including provider outreach via phone, fax, and written requests

Required Skills

• HEDIS medical record abstraction
• Quality measure compliance and auditing
• Medical terminology and chart review
• Strong understanding of current HEDIS Technical Specifications
• Knowledge of HEDIS audit processes (PSV, CSV, MRRV)
• Ability to interpret and abstract clinical documentation accurately
• Proficiency with medical record abstraction tools
• Proficiency in Microsoft Excel, Word, PowerPoint, and Outlook
• Strong written and verbal communication skills
• Ability to work independently and meet productivity and accuracy benchmarks

Must-Have Experience

• 3–5 years of experience in HEDIS data, chart review, and medical record abstraction
• Experience abstracting preventive screenings, immunizations, diabetic labs, HPV testing, maternity, and pediatric care
• Ability to maintain defined productivity standards
• Ability to achieve and sustain a 98% abstraction accuracy rate
• Ability to work under deadlines and pressure while maintaining quality standards

Nice-to-Have

• 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

Education / Qualifications

• Associate’s degree, RN, LPN, or equivalent relevant work experience

Job Tags

Similar Jobs