HEDIS Data Reviewer

HEDIS Data Reviewer

The HEDIS Data Reviewer is responsible for performing high-volume, detail-oriented medical record abstraction, overread, and quality review activities in support of annual Healthcare Effectiveness Data and Information Set (HEDIS), State EQRO, and other quality reporting initiatives. This role requires a highly productive, accurate, accountable, and self-motivated individual who can work independently in a fast-paced, deadline-driven environment while maintaining strong attention to detail, professional communication, and a solutions-focused approach to changing priorities.

Duties

• Perform medical record abstraction including data entry into tool, overread, and quality review using applicable HEDIS, State, and project-specific technical specifications.
• Apply structured abstraction and auditing criteria to determine whether medical record documentation supports compliance with measure requirements.
• Accurately enter abstraction, audit, and review results into designated software applications and databases within established timelines.
• Develop and maintain working knowledge of mandated HEDIS, State, and project-specific performance measures, including measure requirements, exclusions, numerator criteria, documentation standards, and audit expectations.
• Complete assigned abstraction and overread work in live software environments while providing clear feedback when documentation does not meet HEDIS, State, or project-specific criteria.
• Coordinate and support medical record identification, collection, retrieval, review, and follow-up activities as assigned.
• Consistently meet or exceed established productivity expectations while maintaining required accuracy, quality, and turnaround time standards.
• Maintain an abstraction proficiency rate of 98% or higher by accurately reading, interpreting, and abstracting documentation from medical record components such as progress notes, consultations, medication forms, treatment plans, health histories, interval histories, and past medical histories.
• Assist with medical record collection activities, including provider outreach, phone calls, fax or letter follow-up, and chart retrieval requests as assigned.
• Manage multiple project assignments, shifting priorities, and competing deadlines while maintaining accuracy, productivity, and professional communication.
• Proactively identify questions, documentation gaps, workflow barriers, or potential quality concerns and escalate them timely through appropriate channels.
• Demonstrate accountability for assigned work, including timely completion, accurate documentation, follow-through on feedback, and appropriate escalation of issues before delays occur.
• Adapt to changing project needs, measure updates, workflow changes, tool enhancements, and operational priorities in a professional and solutions-focused manner.
• Complete additional designated projects, special assignments, testing, training, or operational support activities as assigned.

Skills

• Three to five years of experience working with HEDIS data, medical record review, chart abstraction, chart collection, quality reporting, QRS, STARs, or similar healthcare quality initiatives preferred.
• Knowledge of medical terminology and basic charting, including diabetic labs, HPV testing, preventive health screenings, immunizations, well-care terminology, maternity care, pediatric care, adult care, and related clinical documentation.
• Understanding of current HEDIS Technical Specifications and ability to apply measure guidance consistently.
• Knowledge of HEDIS audit processes, including PSV, CSV, MRRV, and audit-ready documentation expectations preferred.
• Proficiency in Microsoft Excel, Word, PowerPoint, Outlook, OneNote, Teams, and other software applications used to support medical record review operations.
• Experience using medical record abstraction tools and willingness to learn new abstraction platforms, retrieval tools, databases, and workflow systems.
• Experience in pediatric, maternity, diabetic, preventive care, provider office, health plan, medical record, coding, or quality review settings preferred.
• Familiarity with Cancer Registry documentation and Bright Futures guidance preferred.
• Strong written and verbal communication skills, critical thinking skills, organizational skills, and ability to document and communicate questions or barriers clearly.
• Ability to work independently, manage time effectively, remain organized, and meet deadlines in a high-volume production environment.
• Strong attention to detail with demonstrated ability to maintain accuracy while reviewing complex or lengthy medical record documentation.
• Self-motivated with the ability to take initiative, identify next steps, follow through on assignments, and ask appropriate questions without repeated prompting.
• Receptive to feedback and able to consistently apply coaching, audit findings, updated guidance, and process changes to future work.
• Professional, dependable, adaptable, and solutions-focused when responding to workflow changes, competing priorities, feedback, or project challenges.

Education

• High school diploma or GED required.
• Bachelor's degree preferred.
• LPN, CNS, APRN, or RN preferred.
• Medical record professionals and coders with demonstrated expertise in HEDIS abstraction will also be considered.

EEO: "Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."