HEDIS (Medical Review & Quality Specialist)

About the position The HEDIS (Medical Review & Quality Specialist) position involves retrieving and reviewing medical records to ensure compliance with HEDIS measures and HIPAA regulations. This role is essential for supporting quality improvement initiatives within the healthcare system, requiring strong organizational and communication skills to effectively interact with healthcare providers and manage data accurately.

Responsibilities

• Retrieve medical records via EMR or fax request, ensuring compliance with HIPAA and member confidentiality requirements.

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• Call provider offices to request or validate facility and provider addresses, and/or collect medical records for the HEDIS project.

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• Upload records upon receipt and document all outreach efforts.

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• Conduct Medical Record Abstraction and Research during the Medical Record Review Project.

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• Use various software applications to support HEDIS operations by entering data and/or changing chase status for the identified chase(s).

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• Utilize extensive knowledge of HEDIS measures to facilitate medical record abstraction for gap closure and additional data gathering.

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• Create and research Pends and maintain productivity level as specified by the QI Department.

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• Perform all other assigned duties.

Requirements

• 2 years of experience in HEDIS required.

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• Proficient in Microsoft Office (Excel, Word, PowerPoint) and web-based technology.

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• Excellent verbal and written communication skills.

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• Current knowledge of clinical practices and related medical policies.

Nice-to-haves

• Epic Certification preferred.

Benefits

• 401(k)

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• Health insurance

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