The HEDIS Reviewer is responsible for supporting the overall direction, coordination and implementation of the HEDIS Medical Record Review process for Centers Plan for Healthy Living (CPHL) under the direction of the Director of Quality Management. Responsibilities include, but are not limited to coordination of outreach efforts to secure clinical documentation from Providers, reviewing and abstracting data from electronic and/or paper medical records for the annual HEDIS project according to strict HEDIS measure specifications. Documentation of all HEDIS data items into software in a timely manner. Representing CPHL and performing duties in a professional manner as well as utilizing time and resources efficiently.
Type of Experience
A minimum of three (3) years of experience in the health care industry, in HEDIS and/or quality improvement. Experience in a managed care health services environment. Demonstrated knowledge of data collection, medical record review, and data extraction. NCQA and HEDIS experience.
Specific Technical Skills
Proficient use of MS Office with a focus on Excel, and Report writing software
Knowledge of Clinical Software applications
Knowledge and Skills:
# Direct Reports: None
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
· Duties are performed primarily in an office setting
· Regional travel involved
The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification. They should not be construed as an exhaustive list of all responsibilities, duties and skills required.