HEDIS Administrative Coordinator

Job Description

Job Description

Description:

Under the direction of the Supervisor of HEDIS Medical Record Review, the HEDIS Administrative Coordinator

provides administrative and operational support for prospective and retrospective HEDIS medical record retrieval and review activities. The Coordinator prepares and sends medical record requests, tracks request status, conducts follow-up outreach, receives and manages medical record files, and ensures records are accurately named, organized, and routed for review.

This position works closely with the HEDIS Medical Record Review team to support timely completion of medical

record retrieval activities and maintain accurate, organized workflows. Based on experience, training, and business needs, the Coordinator may also perform limited HEDIS medical record abstraction or other Quality support activities.

ESSENTIAL DUTIES AND RESPONSIBILITIES  

  Medical Record Retrieval & Provider Outreach  

• Prepare and submit medical record requests to physician practices, hospitals, and other healthcare providers via fax, secure email, provider portal, or other approved methods.
• Contact provider offices to confirm receipt of requests, clarify request requirements, and obtain status updates.
• Conduct timely and persistent follow-up outreach for outstanding, incomplete, or overdue medical record requests.
• Identify and escalate provider access barriers, repeated non-response, record fees, incorrect contact information, or other retrieval issues.
• Maintain professional and effective communication with provider offices and internal stakeholders throughout the retrieval process.

Request Tracking & Reconciliation 

• Maintain accurate tracking of medical record requests, including request dates, outreach attempts, records received, outstanding records, and final disposition.
• Monitor retrieval work queues and reconcile outstanding requests to ensure appropriate follow-up and closure.
• Update tracking tools and systems timely and accurately to reflect current retrieval status.
• Assist with inventory reconciliation, status reporting, and identification of retrieval risks or delays.

Medical Record File Management 

• Monitor designated fax queues, secure email accounts, provider portals, electronic medical record systems, and other approved record-retrieval channels.
• Download and save medical records received through approved secure sources.
• Perform an initial review of received files to confirm the correct member and requested documentation were received.
• Identify incomplete, illegible, incorrect, duplicate, or missing documentation and initiate follow-up as appropriate.
• Rename medical record files according to established naming conventions and maintain organized electronic file structures.
• Upload, route, or assign medical records to the appropriate reviewer, abstraction queue, or designated storage location.
• Maintain accurate document management practices and protect member information in accordance with organizational privacy and security requirements.

HEDIS Medical Record Review Support 

• Support prospective and retrospective HEDIS medical record review activities, including administrative preparation of records and work queues.
• Assist with medical record abstraction for designated HEDIS measures when appropriately trained and validated.
• Enter or update medical record review information in designated HEDIS, tracking, or workflow systems as assigned.
• Identify potential documentation supporting measure compliance and route records requiring clinical or additional review.
• Participate in HEDIS training, competency validation, and quality review activities when assigned abstraction responsibilities.
• Support special projects, data cleanup, supplemental data activities, audit preparation, and other HEDIS operational needs as assigned.
• Perform other duties as assigned.

EDUCATION AND EXPERIENCE

Education:  

• High school diploma or equivalent required.
• An associate's degree in healthcare administration, health information management, medical assisting, or a related field is preferred.

Required Experience:  

• One (1) or more years of healthcare administrative, medical records, provider-office, health plan, or related experience.
• Experience using Microsoft Outlook, Word, Teams, and Excel.
• Experience managing electronic files and working within web-based systems or portals.
• Demonstrated ability to manage a high volume of requests, maintain accurate tracking, and meet established deadlines.

Preferred Experience:  

• Previous experience with HEDIS, quality improvement, medical record retrieval, chart review, or health plan operations.
• Experience requesting and obtaining medical records from physician practices, hospitals, or other healthcare facilities.
• Experience with EMR/EHR systems, provider portals, secure file-transfer systems, or medical record retrieval platforms.
• Previous HEDIS abstraction or medical chart review experience.
• Medical terminology knowledge or a clinical/health information background (e.g., MA, CNA, LPN, RHIT or equivalent) is a plus.

KNOWLEDGE, SKILLS, AND ABILITIES

Required:  

• Strong organizational skills and attention to detail.
• Strong follow-through and ability to independently manage multiple outstanding requests.
• Professional written and verbal communication skills, including comfort communicating with provider offices by phone, fax, and email.
• Ability to perform repetitive, high-volume administrative work accurately and efficiently.
• Ability to recognize missing, incorrect, incomplete, or illegible documentation.
• Ability to prioritize competing tasks and meet time-sensitive HEDIS deadlines.
• Ability to work independently and effectively in a remote environment.
• Understanding of HIPAA and appropriate handling of protected health information.
• Proficiency with Microsoft Office applications and electronic document/file management.

Preferred

• Familiarity with NCQA HEDIS terminology and medical record review workflows.
• Knowledge of common medical terminology and clinical documentation.
• Ability to learn HEDIS measure-specific documentation requirements and abstraction workflow

PHYSICAL REQUIREMENTS 

• Exerting up to 10 pounds of force occasionally (up to 1/3 of the time) and 
• A negligible amount of force frequently (1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. 
• Sedentary work involves sitting most of the time but may involve brief walking or standing. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.