HEDIS Abstractor (NorCal Region)

HEDIS Abstractor (NorCal Region)

The HEDIS Abstractor supports Quality Care Improvement initiatives by conducting comprehensive medical record reviews and abstraction activities to identify and close HEDIS measure care gaps. This role is responsible for ensuring accurate collection, validation, and submission of clinical data in accordance with NCQA HEDIS technical specifications and regulatory guidelines. The HEDIS Abstractor collaborates with internal quality teams, providers, and external audit vendors to improve measure performance, maintain compliance, and support successful HEDIS audits.

What You'll Do

• Perform medical record abstraction and chart review for HEDIS and quality improvement initiatives
• Identify and close HEDIS care gaps through accurate review and documentation of clinical records
• Interpret and apply HEDIS measure specifications, coding guidelines, and NCQA technical requirements
• Review and validate data for accuracy, completeness, and compliance with HEDIS standards
• Conduct quality assurance (QA) reviews of abstracted records and audit findings
• Collaborate with providers, clinics, health plans, and internal departments to obtain required medical documentation
• Partner with external audit vendors to support medical record retrieval, validation, and audit readiness activities
• Analyze abstraction results and identify trends, discrepancies, or opportunities for process improvement
• Ensure compliance with HIPAA and all applicable privacy and confidentiality regulations
• Maintain productivity and accuracy standards while meeting project deadlines
• Support continuous quality improvement initiatives and assist with reporting activities as needed
• Other duties as assigned

Qualifications

• High school diploma or equivalent required; associate or bachelor's degree in healthcare-related field
• Have at least 2 years of HEDIS abstraction or medical record review experience
• Strong knowledge of NCQA HEDIS measure specifications and quality improvement processes
• Proficiency with ICD-10, CPT, HCPCS, and other clinical coding systems
• Experience performing QA reviews and supporting HEDIS audit activities
• Familiarity with EMR/EHR systems and healthcare documentation workflows
• Strong analytical, organizational, and problem-solving skills
• Excellent attention to detail and accuracy
• Ability to work independently and manage multiple priorities in a fast-paced environment
• Strong written and verbal communication skills

• Certified Professional Coder (CPC), RHIT, RHIA, LVN/LPN, RN, or other healthcare-related certification
• Experience working with health plans, managed care organizations, or quality improvement departments
• Knowledge of CMS Stars, risk adjustment, and population health initiatives strongly preferred

Environmental Job Requirements and Working Conditions

• Our organization follows a hybrid work structure. This role will require traveling locally to provider offices located in the San Francisco bay area for up to 35% of the time. When not conducting onsite visits, the role supports remote work.
• The annual total compensation target pay range for this role is: $27.00 - $33.00 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at View email address on click.appcast.io to request an accommodation.

About Astrana Health, Inc.

Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient. Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.