HEDIS Reviewer

Overview

The HEDIS Reviewer II participates in member and provider outreach, collects and reviews medical records for compliance. Comprehensive training will be provided before the assignment begins.

Position Summary
Participates in the collection and review of medical records to abstract clinical information for HEDIS quality reporting. Training will be provided prior to the start of the assignment.

This position interprets relevant clinical criteria through review of medical records, annotates via Adobe PDF and populates a data collection tool to support compliance with HEDIS and CMS performance measures. Ensures accurate and complete documentation of required information to meet risk management, regulatory, and accreditation requirements. The candidate must be proficient with databases and with conducting 100% of work activities on the computer.

Job Duties and Responsibilities:

• Conduct outreach to members to complete surveys addressing Social Determinants of Health (SDoH) barriers and provide helpful resources.
• Coordinate care by reaching out to members and clinical providers to obtain medical records and ensure patients receive preventive and chronic disease management services. This includes reminding providers about screenings, identifying completed screenings, and assisting with pending ones.
• Search for relevant HEDIS records in databases, review medical records using HEDIS technical specifications or internal guidelines, and annotate via Adobe PDF.
• Ensure accurate and complete documentation to meet risk management, regulatory, and accreditation requirements.
• Perform additional ad-hoc projects such as verifying provider demographics and faxing providers.
• The candidate must be proficient with Excel and with conducting 100% of work activities on the computer.
• Complete assigned abstraction and data entry each day.
• Work with provider offices as needed to schedule/confirm appointments, follow up on medical record submission, and provide patient rosters
• Locate and review ALL assigned medical charts, perform abstraction, copy all supporting documentation per specifications and data enter into the applicable software system ALL assigned abstracts.
• Prioritize and accurately complete tasks within established times
• Identifying trends and documentation of areas for improvement
• Maintaining project productivity levels while maintaining accuracy requirements for abstraction and data entry activities

Experience

• 0-3 seasons of experience auditing and abstracting medical records required
• Candidate must commit to attend all required training and conference calls assigned for the project.
• Candidate must return all equipment that is supplied to them in good working condition and in a timely manner at the end of the project
• Medical knowledge/terminology is required.
• Ability to read and interpret medical records.
• Professional demeanor and good work ethic.
• Computer savvy: Microsoft Word, Excel, email, and Adobe reader required. Know how to save a file to a folder.
• Excellent verbal and written communication skills – clear, concise and appropriate.
• Conscientious problem solver, willing to learn, and take personal pride in their work performance/accuracy.
• Exceptional attention to detail and excellent analytical, investigation, and problem-solving skills
• Proven organizational and time management skills including the ability to meet required deadlines
• Must keep all information collected in a safe, organized and confidential manner while maintaining confidentiality of PHI, HIPAA Privacy and Security Rules

The target hiring compensation range for this role is $27.88 to $31.88 an hour. Compensation is based on several factors including, but not limited to education, relevant work experience, relevant certifications, and location.

About Aquent Talent:

Aquent Talent connects the best talent in marketing, creative, and design with the world’s biggest brands.

Our eligible talent get access to amazing benefits like subsidized health, vision, and dental plans, paid sick leave, and retirement plans with a match. We also offer free online training through Aquent Gymnasium. More information on our awesome benefits! 

Aquent is an equal-opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics. We’re about creating an inclusive environment—one where different backgrounds, experiences, and perspectives are valued, and everyone can contribute, grow their careers, and thrive.

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