Hedis Abstractor
Blue Cross Blue Shield companies
Blue-Cross-Blue-Shield-Association seeks a HEDIS Data Quality Specialist to lead data quality strategy, oversee HEDIS portal, and drive performance improvements with cross-functional teams. The role supports HEDIS reporting for NCQA and FEHBP, utilizing SAS, SQL, Cognos, and MCSource for advanced analytics. The position emphasizes end-to-end testing, data integrity, and effective communication with business partners to optimize data and address defects. #J-18808-Ljbffr
- ...HEDIS Specialist Under the direction of the HEDIS Program Manager, supports the annual HEDIS project management by coordinating... ...medical record vendor oversight. Assists Manager in training abstractor staff and participates in the medical record IRR. Identifies...HEDISWork at office
- ...and steadily grow. Job Description Under the direction of the HEDIS Program Manager, supports the annual HEDIS project management by... ...medical record vendor oversight. Assists Manager in training abstractor staff and participates in the medical record IRR. Identifies member...HEDISWork at office
- ...Description: This position supports the data collection of HEDIS clinical data set tied to technical specifications; auditing and review of electronic clinical records to ensure data accurately reflect medical record documentation to meet HEDIS regulatory compliance...HEDIS
- Blue Cross Blue Shield Association is seeking a specialist to lead HEDIS data quality and submission efforts for NCQA. You will oversee the HEDIS portal, profile QCR data, and drive cross-functional quality improvements across plans and vendors. You will apply extensive...HEDIS
- A healthcare solutions provider based in Chicago is seeking an individual for a crucial role involving auditing electronic clinical records to ensure compliance with regulatory standards. Responsibilities include conducting analyses, maintaining documentation procedures...HEDIS
- ...the intersection of business engagement, product engineering, and healthcare data strategy, with an initial focus on data quality and HEDIS reporting, evolving into predictive analytics and STARs performance optimization.This individual will serve as a subject matter...HEDISFull time
- Blue Cross Blue Shield Association (BCBSA) oversees HEDIS data quality and reporting strategies to optimize NCQA submissions. The role coordinates cross-functional teams, supports QA testing, and drives data improvements across plans and vendors. The candidate will analyze...HEDIS
- ...quality improvement studies to reach established targets Interface with Commercial and Government entities on care coordination, HEDIS and other QI activities Report to UM/QM Committee on progress toward goals and make recommendations for improvement Other duties...HEDIS
- ...Practitioners we seek are those who have directly related experience in geriatric primary care managing chronic conditions in alignment to HEDIS/STAR quality outcomes. The Nurse Practitioner who wants to practice medicine with a focus on patient care, not volume. We want our...HEDISWork at officeMonday to Friday
- ...Practitioners we seek are those who have directly related experience in geriatric primary care managing chronic conditions in alignment to HEDIS/STAR quality outcomes. The Nurse Practitioner who wants to practice medicine with a focus on patient care, not volume. We want our...HEDISWork at officeMonday to Friday
$115k - $150k
...utilized throughout the organization. Required Background: ~834 healthcare transactions ~837 healthcare claims transactions ~ HEDIS ~ Strong SQL ~ Snowflake ~ Healthcare data experience ~ Data engineering and transformation experience The Opportunity:...HEDISFull timeRemote work$280k
...a leadership role at a community health center.You understand quality as a system problem, not a compliance exercise.UDS measures, HEDIS rates, and HRSA site visit readiness matter here, but they are not the goal. The goal is that Mrs. Garcia's diabetes is well-managed...HEDISHourly payContract workRelocationAfternoon shift- Job Description Summary:This position supports and executes the Healthcare Effectiveness Data and Information Set (HEDIS) data quality strategy for optimal HEDIS submission to National Committee for Quality Assurance (NCQA). Responsibilities include oversight of the HEDIS...HEDISFull timeShift work
$99k - $232k
...Prior consulting or advisory firm experience preferred- Contributing to commercial analytics product development- Familiarity with NCQA HEDIS specifications and CMS Star Ratings- Knowledge of government payer programs and Medicaid- Experience with NLP or unstructured...HEDISFull timeH1b- ...management, care management, pharmacy, provider and provider groups, surveys and Healthcare Effectiveness Data and Information Set (HEDIS).Produces data, reports and analysis for population assessments, Utilization, Care Management, Quality, Annual Report, Centers for Medicare...HEDISFull timeWork experience placementWork at office
$198.18k - $278.05k
...lists and gap closure data are delivered to Plans• Facilitate consultative support for Plans on evidence-based interventions to improve HEDIS, administrative, and Part D Stars measures• Coordinate with BHI on Stars benchmarking and tracking Annual Wellness Visit and...HEDISFull timeContract workWork at officeLocal areaShift work- ...health) Conduct outbound calls for Appointment reminders and No-show follow-up and re-engagement Preventive care outreach (e.g., HEDIS gaps, chronic care follow-ups) Support patient retention initiatives, especially for "lost to care" populations Answer and manage...HEDISFull time
$118.06k - $168.66k
...adherence, and managing chronic diseases to improve patient outcomes and elevate quality performance metrics such as CMS Star Ratings and HEDIS scores. The ambulatory pharmacist partners closely with patients, physicians, advanced practice providers, nurses, and care teams to...HEDISHourly payFull timeLocal areaFlexible hoursWeekend workAfternoon shift- ...and interdisciplinary team required. Ability to meet accreditation and quality standards including, but not limited to NCQA, PCMH, HEDIS through following defined procedures to assess, intervene and document interactions. Ability to work independently and exercise excellent...HEDISWork at office
$80k - $90k
..., and providing direct clinical care for complex cases. Strong understanding of value-based outcomes, quality programs (NCQA, PCMH, HEDIS), and performance management. Excellent computer skills (Microsoft Office Suite, EMR systems) and written/oral communication abilities...HEDISWork at officeImmediate startWork from homeDay shift- ...Nursing (BSN) preferred Bilingual English/Spanish preferred Certification in Care Management or related specialty preferred Knowledge of HEDIS and Stars measures preferred Core Competencies Demonstrates expertise in conducting comprehensive assessments, care coordination,...HEDISWork at officeRemote work
- ...leadership experiences in management positions Certified Case Manager (CCM) preferred Knowledge/experience in Medicare/Medicaid and HEDIS criteria is highly desirable Valid Driver's License and vehicle required Ability to travel at least 30% for client meetings...HEDISWork from home
$237.5k - $384k
...clinicians, case management, and social work to address medical and psychosocial needs, while supporting quality initiatives including HEDIS, RAF accuracy, and patient experience.Primary Responsibilities: - - - -Manage a panel of complex Medicare patients as the PCP,...HEDISMinimum wageWork experience placementLive inLocal areaWork from homeRelocationRelocation packageFlexible hours$80k - $100k
...infection prevention and patient safety standards. Support the implementation and monitoring of clinical quality measures, including HEDIS, UDS, value-based care, and patient satisfaction initiatives. Conduct routine site visits, audits, and performance evaluations to...HEDISLocal areaWeekend workAfternoon shift- ...ensuring awareness regarding patient care plans* Providing assistance with preventative health care ‘pay-for-performance’ services (HEDIS), medication review and reconciliation with a licensed professional for medication adjustment, and ensure care coordination across the...HEDISFull time
$81.36k - $118.2k
...standards. Support care transitions, end‑of‑life discussions, palliative care interventions, and the closure of preventive care and HEDIS quality gaps, including screenings and medication adherence initiatives. Complete and submit all required documentation, reports, and...HEDISWork at officeLocal areaRemote work$78.8k - $177.68k
...applications (e.g., cost of care, quality measurement, utilization management). Familiarity with key industry metrics and frameworks, such as HEDIS, population health, risk adjustment, and value-based payment models. Prior experience in a consulting firm, health plan, or health...HEDISFull timeWork experience placementRemote workFlexible hours$28 - $30 per hour
...daily work. Leverage all quality related resources to ensure accuracy and completeness of work measure/project instructions, NCQA/HEDIS® specifications, coding documents, quick reference guides. Prioritize daily work to meet various quality reporting deadlines and...HEDISBi-weekly payHourly payFull timeTemporary workFor contractorsLocal areaRemote workWork from homeFlexible hours$60k - $75k
...tolerance for detail are essential attributes. Familiar with state and federal regulatory reporting. Knowledge of quality data including HEDIS reporting, interventions, and STAR ratings. Excellent communication and analytical skills. Excellent verbal and written...HEDISFull timeWork at officeImmediate start- ...department to develop/ implement education relevant to Health centers. Collaborates with CountyCare and Managed Care Network to ensure HEDIS measures are met and high/moderate risk patients are appropriately identified and receive care/support. Performs other related...HEDIS
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