Summary: The HEDIS Data Reviewer is responsible for abstracting, reviewing, and auditing medical records to support annual Healthcare Effectiveness Data and Information Set (HEDIS) and State EQRO quality reporting. This role involves coordinating medical record collection, applying HEDIS specifications, and maintaining high levels of accuracy and productivity.

Position Info:

• Title: HEDIS Data Reviewer
• Client: AmeriHealth Caritas
• Duration: 3 Months
• Location: 3875 West Chester Pike Newtown Square PA 19073
• Work Mode: Remote

Responsibilities:

• Coordinate medical record identification, collection, and review processes.
• Apply structured auditing criteria to assess compliance with HEDIS and State measures.
• Accurately enter audit results into databases using various software applications.
• Maintain expertise in HEDIS and State performance measures, ensuring accurate data abstraction.
• Support medical record collection efforts, including contacting providers and facilitating chart retrieval.

Skills/Qualifications:

• 3-5 years of experience with HEDIS data, including chart review and collection; experience with HEDIS, QRS, or STARs.
• Proficiency in medical terminology, especially in areas such as diabetic labs, immunization, and preventive health screenings.
• Familiarity with HEDIS audit processes, medical record abstraction tools, and relevant software (Excel, Word, PowerPoint, Outlook).
• Strong organizational, communication, and critical thinking skills.
• Associate's Degree or equivalent relevant experience.