Job Details

HJ Staffing is seeking a highly detail-oriented HEDIS Data Reviewer to join our team in support of our client. Working under the direction of the Manager of Medical Record Review Operations, you will be responsible for performing medical record abstraction and overread in support of Quality reporting (annual HEDIS and State EQRO).
Job Description

The HEDIS Data Reviewer ensures the integrity and accuracy of clinical data by performing comprehensive medical record reviews. You will play a vital role in determining compliance with national quality standards and state performance measures.
What You Will Do

• Coordination & Collection: Manage the medical records identification process, including collection activities, provider outreach (calls/faxes), and chart retrieval requests.
• Clinical Abstraction: Apply structured auditing criteria to medical records to determine compliance with HEDIS and State Measure Technical Specifications.
• Data Management: Utilize specialized software applications to accurately enter chart audit results into the database and provide real-time feedback.
• Maintain Proficiency: Maintain a minimum 98% abstraction proficiency rate by correctly interpreting various record components such as consultations, medication forms, and health histories.
• Strategic Review: Develop and maintain expertise in mandated HEDIS requirements and perform overreads to ensure data quality in a live software environment.
• Productivity: Consistently meet or exceed the minimum volume of chases/charts per defined period as required by policy.

• You have a deep understanding of current HEDIS Technical Specifications and audit processes (PSV, CSV, and MRRV).
• You are proficient in Microsoft Office (Excel, Word, PowerPoint, and Outlook).
• You are familiar with the Cancer Registry and Bright Futures guidelines.
• You possess strong written and oral communication, critical thinking, and organizational skills.
• You are able to work independently and effectively under the pressure of strict deadlines.

• Experience: 3-5 years of HEDIS data experience (chart review/collection). Experience with QRS or STARs is highly preferred.
• Knowledge: Expertise in medical terminology and charting (diabetic labs, HPV testing, preventive screenings, and immunization/well-care terminology).
• Education: Associate's Degree, RN, LPN, or equivalent relevant work experience.
• Software: Experience with medical record abstraction tools and a willingness to learn new platforms.
• Background: Experience in Pediatric, Maternity, Diabetic, or Provider Office settings.

• Location: Hybrid - 3 days onsite in Philadelphia, PA.
• Schedule: 8:00 AM - 5:30 PM EST, Monday - Friday (some weekend work may be required).