Job Description

Job Title: HEDIS Data Reviewer

Location: Philadelphia, PA 19113

Work Arrangement: Hybrid – 3 days onsite, 2 days remote

Schedule: 8:00 AM – 5:30 PM EST, Monday–Friday (some weekends may be required)

Position Summary

The HEDIS Data Reviewer supports quality reporting by reviewing and abstracting medical records for HEDIS and State EQRO measures. This role ensures data accuracy, compliance with technical specifications, and timely completion of assigned records.

Key Responsibilities

• Review and abstract medical records in alignment with HEDIS and State performance measures.
• Enter chart audit results accurately into databases and maintain data integrity.
• Coordinate medical record retrieval and ensure timely completion of assigned chases.
• Maintain a minimum 98% accuracy in abstraction.
• Support provider offices with chart collection activities.
• Meet productivity and quality standards for chart reviews.

Required Qualifications

• Experience: 3–5 years in HEDIS data review, chart abstraction, or medical record collection.
• Knowledge: Strong understanding of HEDIS Technical Specifications, medical terminology, and healthcare quality programs (QRS/STARs).
• Technical Skills: Proficient in Excel, Word, Outlook, and medical record abstraction tools.
• Clinical Background: RN, LPN, or experience in Pediatric, Maternity, Diabetic, or Provider Office settings.
• Soft Skills: Excellent communication, organization, and critical thinking; able to work independently under tight deadlines.

Education

Associate’s Degree in a related field or equivalent experience (RN/LPN preferred).

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