Salary: $25.00–$40.00
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What They’re Looking For
High school diploma or equivalent is required, and additional education in healthcare, clinical fields, medical coding, or health information management is preferred. Candidates must have 4 to 5 or more years of direct HEDIS experience, including hands-on medical record review and clinical data abstraction, with prior experience performing HEDIS quality audits, validation, and quality assurance reviews. Preferred experience includes Medicare, Medicaid, and commercial health plan HEDIS projects, hybrid HEDIS data collection and medical record retrieval, NCQA quality reporting standards, and familiarity with HEDIS software, EMRs, and data abstraction platforms.
Skills to Showcase on Your Resume
HEDIS, HEDIS Measure Interpretation, HEDIS Technical Specifications, Clinical Data Abstraction, Medical Record Review, Quality Auditing, Validation Review, Quality Assurance, NCQA Quality Reporting Standards, Medicare HEDIS, Medicaid HEDIS, Commercial Health Plan HEDIS, Hybrid HEDIS Data Collection, Medical Record Retrieval, EMR Systems, HEDIS Software, Adobe Acrobat PDF Annotation, Microsoft Excel, Microsoft Word, HIPAA Compliance
Job Description
Pay Rate: $25.00–$40.00 per hour
Experience Required: 4–5+ years of HEDIS experience
Work Location: 100% Remote
Schedule: Monday–Friday, 8:00 AM–5:00 PM local time
Position Overview
We are seeking a highly experienced HEDIS Medical Record Abstractor, Reviewer, and Auditor with a minimum of 4–5 years of hands-on HEDIS experience. The ideal candidate will have a strong background in medical record review, clinical data abstraction, HEDIS measure interpretation, quality assurance, and auditing. This position requires an experienced professional who can independently review complex medical records, identify and abstract clinical data, validate documentation against HEDIS measure specifications, and ensure accuracy and compliance with HEDIS reporting requirements. The successful candidate must be detail-oriented, highly organized, productive, and knowledgeable about HEDIS quality measures and medical record documentation.
Key Responsibilities
- Review and abstract clinical information from medical records for HEDIS quality reporting.
- Perform detailed medical record reviews to identify supporting documentation for applicable HEDIS measures.
- Interpret HEDIS technical specifications, clinical criteria, and measure requirements.
- Conduct quality audits and validation reviews of abstracted medical records to ensure accuracy, completeness, and compliance.
- Identify missing, incomplete, or inconsistent clinical documentation and determine appropriate follow-up.
- Apply clinical knowledge to accurately identify numerator compliance, exclusions, exclusions criteria, and denominator eligibility as applicable to assigned measures.
- Annotate and highlight medical records using Adobe Acrobat/PDF tools.
- Enter accurate clinical abstraction results into designated HEDIS data collection systems.
- Perform quality assurance checks and resolve abstraction discrepancies.
- Coordinate with provider offices to obtain medical records, schedule record reviews, confirm appointments, and follow up on outstanding documentation.
- Prepare and distribute patient rosters and maintain accurate tracking logs.
- Identify documentation gaps, trends, and opportunities for quality improvement.
- Meet established productivity, accuracy, and turnaround-time expectations.
- Maintain strict HIPAA compliance and confidentiality of protected health information.
Required Qualifications
- Minimum 4–5 years of direct HEDIS experience.
- Strong hands-on experience with HEDIS medical record review and clinical abstraction.
- Previous experience performing HEDIS quality audits, validation, and quality assurance reviews.
- Demonstrated knowledge of HEDIS measures, technical specifications, and clinical documentation requirements.
- Experience reviewing medical records across multiple clinical specialties.
- Ability to independently identify supporting documentation and determine whether clinical criteria are met.
- Experience identifying abstraction errors, missing documentation, and discrepancies.
- Strong understanding of HIPAA privacy and security requirements.
- Excellent attention to detail, organization, and time management.
Preferred Experience
- Experience with Medicare, Medicaid, and commercial health plan HEDIS projects.
- Experience with hybrid HEDIS data collection and medical record retrieval.
- Knowledge of HEDIS measure year specifications and updates.
- Experience with NCQA quality reporting standards.
- Experience with medical record auditing, re-abstraction, and inter-rater reliability reviews.
- Familiarity with HEDIS software, electronic medical records (EMRs), and data abstraction platforms.
Technical Requirements
- Proficiency with Adobe Acrobat/PDF annotation tools.
- Microsoft Excel and Word.
- Database and data entry systems.
- Email and electronic file management.
- Reliable high-speed internet and Ethernet connection.
- Private, secure, and uninterrupted home workspace.
Education
- High school diploma or equivalent required.
- Additional healthcare, clinical, medical coding, or health information management education is a plus.
Work Schedule & Benefits
- Fully remote position.
- Monday–Friday, 8:00 AM–5:00 PM local time.
- Attendance at required training sessions and conference calls is mandatory.
- Full-time employee benefits available after 90 days.
- 401(k) with company match available after one year of employment.
Ideal Candidate
The ideal candidate is an experienced HEDIS professional who can hit the ground running with minimal supervision. They should have extensive experience reviewing, abstracting, auditing, and validating medical records while maintaining high levels of accuracy and productivity.