Quality Improvement Abstractor

Centene Corporation

5d•$27 - $49•Remote

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. REMOTE OPPORTUNITY! Centene is seeking a Quality Improvement Abstractor to support quality initiatives through accurate data abstraction, review, and validation of clinical data. The ideal candidate will have experience with HEDIS, quality measure abstraction, and overreads, ensuring accuracy, compliance, and consistency with established guidelines. This role is ideal for detail-oriented professionals with a strong understanding of quality measures and experience ensuring data accuracy through abstraction and overread processes. Position Purpose: Lead data collection and abstraction for company quality measures, including HEDIS, CMS, CHIPRA and/or any other custom measurements. Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards Review medical records and abstract data for HEDIS and other measure sets in compliance with standards Track and report on issues and outcomes related to abstractions and over-reads Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required Perform other quality initiatives as necessary Performs other duties as assigned Complies with all policies and standards

Requirements

Experience with HEDIS, quality measure abstraction, and overreads
Familiarity with healthcare quality improvement processes, metrics, and documentation standards
Strong attention to detail and ability to interpret clinical records accurately
Ability to work Monday–Friday, 8:00 AM–5:00 PM EST
Must reside in the Eastern (EST) or Central (CST) Time Zone
Associate’s degree in related field or equivalent experience.
4+ years of nursing, medical assistant, medical coding or data management experience.

Nice To Haves

RN or LPN license preferred (not required)
Bachelor degree preferred.
Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards) preferred.
Current state’s RN or LPN license preferred.

Responsibilities

Lead data collection and abstraction for company quality measures, including HEDIS, CMS, CHIPRA and/or any other custom measurements.
Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards
Review medical records and abstract data for HEDIS and other measure sets in compliance with standards
Track and report on issues and outcomes related to abstractions and over-reads
Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required
Perform other quality initiatives as necessary
Performs other duties as assigned
Complies with all policies and standards