Quality Improvement Abstractor

Position Title : Quality Improvement Abstractor


Work Location : Remote NC - Candidates must reside in NC


Assignment Duration: 7 months


Work Schedule : Training 2-week course M-F 8am-5pm EST; Working scheduleM-F 8am-5pm EST; No OT


Work Arrangement : Remote

Position Summary:


Lead data collection and abstraction for company quality measures, including HEDIS, CMS, CHIPRA and/or any other custom measurements.

Background & Context:


The purpose of the HEDIS contractor team is to support medical record retrieval and data collection activities in preparation for HEDIS season. By bringing these resources on ahead of the official season, we are able to get a head start on closing care gaps, ensuring records are obtained, documented, and uploaded accurately and timely to support abstraction and reporting needs. The HEDIS contractors work closely with the NC Quality team in a highly collaborative and supportive environment. The culture is fast-paced but team-oriented, with clear processes, training, and ongoing guidance provided to ensure contractors are set up for success.

Key Responsibilities:


* Assist with retrieval of medical records.


* Works with the HEDIS Ops and Risk Adjustment teams to collect member records by contacting providers and placing collected records into database utilized


* Required to handle a high-volume (40-50 per day) of inbound and outbound calls with provider offices


* Continued follow up on requested medical records until obtained


* Excellent documentation of research and contact information


* Labeling records with appropriate naming convention


* Loading medical records to abstraction database


* Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards


* Review medical records and abstract data for HEDIS and other measure sets in compliance with standards


* Track and report on issues and outcomes related to abstractions and over-reads


* Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required


* Perform other quality initiatives as necessary


* Performs other duties as assigned


* Complies with all policies and standards

Candidate Requirements

Education/Certification
Required: Required: Associate Degree RN - NC or Compact state license
Preferred: Bachelor degree preferred

Licensure
Required: LPN - NC
Preferred: RN - NC or Compact state license

Years of experience required:


* Minimum 4 years of nursing experience (active RN required)


* At least 1 year of experience in medical record review, quality improvement, or related administrative clinical work, call center


Disqualifiers:


* No active RN/LPN license or lapsed/expired license


* Lack of experience with medical record systems or electronic documentation


* Inability to commit to full-time schedule during the contract period


* Limited computer proficiency (unable to navigate Excel or complete required computer testing)


* Refusal or inability to be on camera for required training and testing

Additional qualities to look for:


* Strong organizational skills and attention to detail


* Ability to handle a high-volume workload under tight timelines


* Professional communication and follow-up skills with provider offices


* Reliability and accountability in meeting daily call/fax and documentation expectations

• Top 3 must-have hard skills stack-ranked by importance

1
Medical record retrieval and documentation accuracy (critical for data integrity)

2
Strong computer skills (Excel, medical record software, and ability to pass computer testing)

3
Effective provider communication (handling high call/fax volume with professionalism)