HEDIS Data Reviewer

AI Job Summary : HEDIS Data Reviewer

Location : Philadelphia, PA (Hybrid : 3 days onsite, Stevens Drive)

Duration : 3+ Months | Contract | $45.23 / hr | Schedule : M-F, 8am 5 : 30pm EST, occasional weekends

Role Impact & Expectations :

As a HEDIS Data Reviewer, you will drive the quality and compliance of healthcare reporting by accurately abstracting and reviewing medical records for HEDIS and State EQRO programs. Your work directly supports performance measurement and continuous improvement in patient care outcomes.

Skills Emphasis :

Demonstrated expertise in HEDIS data abstraction, medical record review, and medical terminology is critical. Proficiency with medical record abstraction tools and Microsoft Office is essential for success in this role.

Key Responsibilities :

• Conduct precise medical record abstraction and overread for HEDIS and State EQRO quality reporting.
• Manage identification, collection, and review of medical records using structured abstraction criteria.
• Enter audit results accurately into designated databases or software.
• Maintain at least a 98% abstraction proficiency rate and meet productivity targets.
• Provide detailed feedback on non-compliant records and support providers as needed.
• Assist with record collection via phone, fax, and written requests.
• Complete assigned special projects and comply with established standards.

Recruiter Insights :

Candidate Insights :