HEDIS Data Reviewer

HEDIS Data Reviewer Philadelphia PA

Job Summary
The HEDIS Data Reviewer plays a vital role in ensuring the accuracy and compliance of medical record data for HEDIS and State EQRO quality reporting. Reporting to the Manager of Medical Record Review Operations this position is responsible for medical record abstraction overread and the application of technical auditing standards. The role is integral in supporting healthcare quality initiatives and works in a hybrid environment (3 days onsite Stevens Drive Location) requiring strong attention to detail and proficiency with data management tools.

Emphasis on Skills
This role demands proficiency in HEDIS data abstraction expertise in medical terminology and advanced competence with Excel Word PowerPoint and Outlook. Strong communication organizational and critical thinking skills are essential along with the ability to work independently and meet productivity and accuracy targets.

Key Responsibilities

- Coordinate medical record identification collection and review processes to support quality reporting initiatives.
- Perform structured auditing and abstraction of medical records ensuring compliance with HEDIS and State performance measures.
- Accurately enter chart audit results using specialized software and maintain all required documentation.
- Maintain a proficiency rate of 98% in abstraction interpreting diverse medical record components.
- Provide real-time feedback on records not meeting HEDIS or State measure criteria.
- Support providers with clinical and administrative tasks as directed.
- Assist in the medical record collection process by communicating with provider offices and facilitating chart retrieval.
- Complete additional designated projects as assigned by management.





Recruiter Insights

- Attractive hybrid schedule (3 days onsite work-life balance)
- Opportunity to support critical healthcare quality metrics
- Direct impact on compliance and patient care outcomes
- Competitive for candidates with HEDIS QRS or STARs backgrounds
- Opportunity to leverage and expand expertise in diverse healthcare settings (Pediatric Maternity Diabetic Provider Office)
- Preferred but not mandatory: Bright Futures and advanced abstraction tool experience

Candidate Insights

- Be part of a team driving healthcare quality improvements
- Use and grow your HEDIS and medical abstraction skills in a dynamic supportive environment
- Hybrid work model offers flexibility and stability
- Gain exposure to a variety of medical record types and health initiatives
- Opportunity to meet productivity and accuracy benchmarks and be recognized for excellence in quality data review

Location: Philadelphia PA (Hybrid Stevens Drive Location)
Schedule: Monday Friday 8 am 5:30 pm EST; 8 hours/day 40 hours/week; occasional weekends possible
Education: Associates Degree RN LPN or equivalent experience