Job #: 2099
Title: Hedis Reviewer
The primary function of the HEDIS Retriever – Seasonal is to conduct onsite abstraction of services from medical charts in compliance with HEDIS/QARR, Medicare Advantage Star measure specifications. This position will be an integral part of the annual Medical Record Review project required to report HEDIS and QARR measures to the NYS Department of Health and Centers for Medicare & Medicaid Services (CMS). The role is field-based and seasonal (October of the measurement year through June of the reporting year), approximately seven months.
The position requires the ability to travel within the five boroughs daily.
Perform medical record abstraction via EMR, in-house paper medical records, and on-site provider visits to collect documentation of measure compliance.
Scan large amounts of data quickly and accurately while documenting progress in applicable databases.
Distributes requests for records and schedules appointments with provider offices to ensure timely completion of duties to meet internal and regulatory standards and requirements.
Maintain up-to-date knowledge of HEDIS, QARR and Star specifications.
Responsible for fulfillment of project initiatives, including completion of ad hoc operations projects as needed.
Other duties as assigned by Management.
Completion of high school/GED
Minimum of two years relevant work experience in a managed care, health plan or provider office setting. Clinical background preferred (Medical Assistant, Nursing Assistant, Health Educator, LPN, RN, LMSW or LCSW.
Minimum of two years’ work experience as a HEDIS retriever/abstractor with a HEDIS or RISK vendor or managed care organization, preferred.
Proficient in Microsoft Office applications including Word, Excel, PowerPoint and Access.
Strong written and verbal skills.
Ability to work independently, be motivated and possess excellent organizational skills and attention to detail.
Ability to prioritize to ensure reporting timeframes and deadlines are met.
Ability to travel within the service area as part of daily tour