HEDIS Data Reviewer

HJ Staffing • Philadelphia, PA

1d • Hybrid

About The Position

The HEDIS Data Reviewer ensures the integrity and accuracy of clinical data by performing comprehensive medical record reviews. You will play a vital role in determining compliance with national quality standards and state performance measures.

Requirements

• 3–5 years of HEDIS data experience (chart review/collection). Experience with QRS or STARs is highly preferred.
• 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.
• A deep understanding of current HEDIS Technical Specifications and audit processes (PSV, CSV, and MRRV).
• Proficient in Microsoft Office (Excel, Word, PowerPoint, and Outlook).
• Familiar with the Cancer Registry and Bright Futures guidelines.
• Possess strong written and oral communication, critical thinking, and organizational skills.
• Able to work independently and effectively under the pressure of strict deadlines.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree