Quality Improvement Abstractor
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. Bachelor degree preferred.
- 4+ years of nursing, medical assistant, medical coding or data management experience.
- Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards) preferred.
Nice To Haves
- 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
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
