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Cohere Health · 3 months ago

HEDIS Clinical Terminologist (Contract)

United States

Contract

Remote

Entry, Mid Level

$50/hr - $75/hr

2+ years exp

Cohere Health is a company that delivers AI-powered solutions to streamline access to quality care. They are seeking a detail-oriented and certified HEDIS Clinical Terminologist to validate automated measure results and support quality improvement efforts through medical record data analysis.

Consumer SoftwareHealth CareSaaSSoftware

Responsibilities

Review EHR and PDFs of medical records to collect HEDIS conformant data elements

Be able to validate that our automated solutions are pulling and coding the data appropriately with respect to diagnosis, procedures and services (ICD10, HCPCS, CPT, SNOMED, LOINC)

Adhere to NCQA technical specifications for each HEDIS measure

Familiarity with measure sets like Adult BMI, Breast Cancer Screening, Colorectal Cancer Screening, and CDC measures

Remain current on NCQA reporting standards and evolving measures

Abstract and code clinical data from medical records in a HEDIS and STARS conformant manner

Understand evolving measure criteria, keep current on measure specifications and evaluate clinical documentation to determine compliance with specific HEDIS measure criteria

Work with data and clinical teams to validate clinical and informatics intent

Identify and flag unexpected and discordant technological outcomes supporting opportunities for product improvement

Participate in audits, quality assurance and product improvement activities as needed

Ensure confidentiality and compliance with HIPAA and company policies

Qualification

HEDIS abstraction experienceICD10 codingNCQA HEDIS guidelinesEHR systems familiarityHEDIS abstraction toolsClinical acumenRisk adjustment knowledgeQuality assurance

Required

2+ years of recent HEDIS abstraction experience, including familiarity with STARS measures

Strong clinical acumen with the ability to translate clinical information into codified concepts (e.g.ICD10, HCPCS, CPT, SNOMED, LOINC) - LPN, RN, or Medical Assistant

Strong knowledge of NCQA HEDIS guidelines, CMS STARS specifications, and risk adjustment

Experience using HEDIS abstraction tools