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HEDIS Abstractor

Business Support
0143385 Requisition #

Responsible for HEDIS medical record identification and abstraction. Primary duties may include, but are not limited to: Conducts medical record abstraction audits of medical records. Serves as a resource and subject matter expert on HEDIS quality reviewer processes. Conducts over-reads on HEDIS records for compliance against HEDIS Technical Specifications and ensures feedback is considered. Identifies patterns and interprets clinical handwriting of providers. Gathers and analyzes data, and organizes and writes reports. Educates providers on HEDIS specifications and medical record documentation via various mediums such as HEDIS Encounter Portal Submission Tool, Hybrid Review Tool, HEDIS reference material development, and any other educational pieces for Provider relations, etc. Provides feedback to providers via the HEDIS Encounter Submission Tool for medical records and ensures feedback is considered. Reviews HEDIS Encounter Portal submissions for Star Metrics within given set deadlines. Works on projects as assigned. Develops expertise in the requirements and parameters of mandated HEDIS performance measures on an annual basis. Requires a degree in nursing, healthcare administration, or related field; 2 years of clinical experience including medical record noting, auditing, and data abstraction, and HEDIS experience; or any combination of education and experience, which would provide an equivalent background. Current, unrestricted clinical license appropriate to field of specialty (RN/LPN) required. Active state license required. 2 years of experience as a HEDIS medical chart reviewer preferred. Knowledge of population health (epidemiology) and quality improvement concepts and intervention. Knowledge of population health (epidemiology) and quality improvement concepts and intervention required. Experience with daily operations in a clinical, managed care, hospital care setting including working with provider systems and medical providers required.

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