Job Description

Job Summary

Our client is seeking a HEDIS Reviewer to perform Healthcare Effectiveness Data and Information Set (HEDIS) medical record review, supplemental data validation, data abstraction, and clinical data quality activities. This role utilizes internal and external clinical data sources to support accurate, timely, and compliant collection of clinical data for HEDIS reporting, regulatory submissions, and quality improvement initiatives.

Key Responsibilities

• Perform HEDIS medical record review.
• Conduct supplemental data validation.
• Execute data abstraction activities.
• Perform clinical data quality activities using internal and external clinical data sources.
• Support the accurate, timely, and compliant collection of clinical data for HEDIS reporting.
• Contribute to regulatory submissions and quality improvement initiatives.

Qualifications

• Registered Nurse (ASN or BSN).
• At least 1 year of HEDIS review experience.
• Ability to work independently and manage high-volume workloads.
• Tech-savvy with experience navigating multiple EMR systems, including E Clinical Works (ECW).
• Comfortable working in fast-paced environments while maintaining composure.
• Skilled at exercising discretion when handling confidential information.
• Experience with HEDIS Measures such as BCS-E (Breast Cancer Screening), COL-E (Colorectal Cancer Screening), and EED (Eye Exam for Patients with Diabetes).

Experience

• Minimum of 1 year of HEDIS review experience.

Skills

• Proficiency with various EMR systems, specifically E Clinical Works (ECW).
• Demonstrated ability to work in fast-paced, high-volume environments.
• Strong independent work ethic.
• Excellent discretion and handling of confidential information.
• Knowledge of Healthcare Effectiveness Data and Information Set (HEDIS) measures.

Education

• Registered Nurse (ASN or BSN).

Additional Requirements

• Schedule: Monday – Friday, 8:30 AM to 5:00 PM.
• Required in-office presence Tuesday – Thursday.

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