HEDIS Abstractor
Astrana Health, Inc.•Monterey Park, CA
•$27 - $33•Hybrid
About The Position
The HEDIS Abstractor supports Quality Care Improvement initiatives by conducting comprehensive medical record reviews and abstraction activities to identify and close HEDIS measure care gaps. This role is responsible for ensuring accurate collection, validation, and submission of clinical data in accordance with NCQA HEDIS technical specifications and regulatory guidelines. The HEDIS Abstractor collaborates with internal quality teams, providers, and external audit vendors to improve measure performance, maintain compliance, and support successful HEDIS audits.
Requirements
- High school diploma or equivalent required; associate or bachelor’s degree in healthcare-related field
- Minimum of 2 years of HEDIS abstraction or medical record review experience
- Strong knowledge of NCQA HEDIS measure specifications and quality improvement processes
- Proficiency with ICD-10, CPT, HCPCS, and other clinical coding systems
- Experience performing QA reviews and supporting HEDIS audit activities
- Familiarity with EMR/EHR systems and healthcare documentation workflows
- Strong analytical, organizational, and problem-solving skills
- Excellent attention to detail and accuracy
- Ability to work independently and manage multiple priorities in a fast-paced environment
- Strong written and verbal communication skills
Nice To Haves
- Certified Professional Coder (CPC), RHIT, RHIA, LVN/LPN, RN, or other healthcare-related certification
- Experience working with health plans, managed care organizations, or quality improvement departments
- Knowledge of CMS Stars, risk adjustment, and population health initiatives strongly preferred
Responsibilities
- Perform medical record abstraction and chart review for HEDIS and quality improvement initiatives
- Identify and close HEDIS care gaps through accurate review and documentation of clinical records
- Interpret and apply HEDIS measure specifications, coding guidelines, and NCQA technical requirement
- Review and validate data for accuracy, completeness, and compliance with HEDIS standards
- Conduct quality assurance (QA) reviews of abstracted records and audit findings
- Collaborate with providers, clinics, health plans, and internal departments to obtain required medical documentation
- Partner with external audit vendors to support medical record retrieval, validation and audit readiness activities
- Analyze abstraction results and identify trends, discrepancies, or opportunities for process improvement
- Ensure compliance with HIPAA and all applicable privacy and confidentiality regulations
- Maintain productivity and accuracy standards while meeting project deadlines
- Support continuous quality improvement initiatives and assist with reporting activities as needed
- Other duties as assigned
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
