Job Overview:
We are seeking HEDIS Senior Abstractors that will be responsible for performing data collection and abstraction of medical records, primarily for HEDIS (Healthcare Effectiveness Data and Information Set) projects, and related initiatives. This role includes ensuring the accuracy of data, meeting productivity standards, mentoring entry-level abstractors, and participating in various meetings and quality reviews.
Primary Responsibilities:
HEDIS Sr Abstractor is responsible for supporting the management and execution of HEDIS data collection, analysis, and reporting processes within the organization. This role involves working closely with clinical, operational, and data teams to ensure compliance with HEDIS measures, maximize performance, and support initiatives aimed at improving quality of care and patient outcomes. The HEDIS Sr. Abstractor will play a vital role in data abstraction, documentation review, quality assurance, and performance monitoring, ensuring all metrics are accurately reported for regulatory and accreditation purposes.
Key Responsibilities:
- Data Collection and Abstraction:
- Review and abstract medical records to collect accurate data for HEDIS measures.
- Identify relevant patient charts and records through the HEDIS data collection process.
- Document and report findings in accordance with HEDIS specifications and guidelines.
- Quality Assurance:
- Ensure that all HEDIS data is accurate, complete, and adheres to the required standards.
- Perform regular audits and data verification checks to confirm compliance with HEDIS reporting requirements.
- Reporting and Analysis:
- Compile and analyze HEDIS data for submission to regulatory bodies (e.g., NCQA, CMS).
- Assist in the preparation and submission of HEDIS reports and documentation for performance evaluations and audits.
- Collaboration with Internal Teams:
- Work with the Quality Improvement, Case Management, and Provider Relations teams to ensure accurate data capture and reporting.
- Collaborate with clinical and operational staff to identify opportunities for improving HEDIS performance metrics.
- Regulatory Compliance:
- Stay up-to-date with HEDIS measures, specifications, and changes to healthcare regulations.
- Ensure compliance with all reporting timelines and deliverables.
- Process Improvement:
- Recommend process improvements to enhance data collection and reporting accuracy.
- Identify opportunities to improve clinical workflows and data extraction methods to ensure the best possible performance on HEDIS measures.
- Documentation and Training:
- Maintain accurate records of all HEDIS-related activities.
- Provide training and support to internal staff involved in HEDIS data collection and reporting.
- Other Duties:
- Assist with the development of educational materials for providers regarding HEDIS measures.
- Perform additional duties as needed to support the organization's quality improvement initiatives.
Qualifications:
- Education:
- Bachelor’s degree in healthcare administration, nursing, public health, or a related field (preferred).
or
- Certification in HEDIS or healthcare quality improvement is a plus.
- Experience:
- Experience with HEDIS data collection, reporting, and analysis (preferred).
- Knowledge of healthcare quality measurement, specifically HEDIS and NCQA standards.
- Experience with data abstraction, chart review, and healthcare quality improvement programs.
- Skills:
- Strong analytical skills with the ability to interpret and report data accurately.
- Proficient in Microsoft Office Suite (Excel, Word, PowerPoint), and familiarity with healthcare data management software.
- Excellent organizational and time-management skills.
- Ability to work independently as well as in a team environment.
- Strong written and verbal communication skills.
- Other:
- Ability to manage multiple projects with strict deadlines.
- Attention to detail and high level of accuracy in data reporting.
Physical Requirements:
- Ability to sit or stand for extended periods while reviewing records or working at a computer.
- Ability to lift or carry light materials, such as office supplies, when necessary.