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HJ Staffing · 13 hours ago

HEDIS Data Reviewer

Philadelphia, PA

Full-time

Hybrid

Mid Level

3+ years exp

HJ Staffing is seeking a highly detail-oriented HEDIS Data Reviewer to join their team in support of Impresiv Health. The role involves performing medical record abstraction and overread to ensure compliance with national quality standards and state performance measures.

Staffing & Recruiting

Responsibilities

Manage the medical records identification process, including collection activities, provider outreach (calls/faxes), and chart retrieval requests

Apply structured auditing criteria to medical records to determine compliance with HEDIS and State Measure Technical Specifications

Utilize specialized software applications to accurately enter chart audit results into the database and provide real-time feedback

Maintain a minimum 98% abstraction proficiency rate by correctly interpreting various record components such as consultations, medication forms, and health histories

Develop and maintain expertise in mandated HEDIS requirements and perform overreads to ensure data quality in a live software environment

Consistently meet or exceed the minimum volume of chases/charts per defined period as required by policy

Qualification

HEDIS Technical SpecificationsMedical record abstractionData management softwareMicrosoft OfficeMedical terminologyExperience in Pediatric settingsExperience in Maternity settingsExperience in Diabetic settingsExperience in Provider Office settingsCommunication skillsCritical thinkingOrganizational skills

Required

3–5 years of HEDIS data experience (chart review/collection)

Deep understanding of current HEDIS Technical Specifications and audit processes (PSV, CSV, and MRRV)

Proficient in Microsoft Office (Excel, Word, PowerPoint, and Outlook)

Strong written and oral communication, critical thinking, and organizational skills

Able to work independently and effectively under the pressure of strict deadlines

Expertise in medical terminology and charting (diabetic labs, HPV testing, preventive screenings, and immunization/well-care terminology)

Associate's Degree, RN, LPN, or equivalent relevant work experience

Experience with medical record abstraction tools and a willingness to learn new platforms

Experience in Pediatric, Maternity, Diabetic, or Provider Office settings

Maintain a minimum 98% abstraction proficiency rate by correctly interpreting various record components such as consultations, medication forms, and health histories

Consistently meet or exceed the minimum volume of chases/charts per defined period as required by policy