HEDIS Medical Record Reviewer

ACE Employment Services - Wellesley, MA4.3

Our client is in need of an experienced HEDIS Medical Record Reviewer to work with the staff in Clinical Quality and Compliance department to perform chart audits for the medical record review portion of the HEDIS audit. The medical record reviewer works in an independent, professional manner with network providers to collect clinical data either from providers electronic health records or paper medical records via site visits request of records to offices. This is a 3 month contract with possible extension and starts ASAP!

  • Attends HEDIS Medical Record Review Abstraction Training.
  • Completes inter-rater reliability testing as requested.
  • Complete and Accurate Capture of Data – The HEDIS Reviewer will perform accurate and complete reviews of medical records that lead to the most accurate results according to HEDIS specifications. Information will be obtained from a variety of sources, multiple electronic medical record systems, faxes and medical record information sent in by provider group. This position must abstract review related data accurately and timely on appropriate review tool, either manually or within electronic systems.
  • Follow up - Review staff will contact provider groups for incomplete/missing information. Patience, organization and clear communication is essential.
  • Complete Review on Time: The HEDIS review has a specified window for completion. Complete all assigned reviews by the end of the medical record review period.
  • Ability to work in fast paced busy environment is essential.
  • Works well independently as well as within a team environment.
  • Great interpersonal skills, works well within team atmosphere
  • Strong verbal and written communication style
  • Investigative in nature. Able to find information in places where not expected to find. Exhausts possibilities and asks appropriate questions of staff.
  • High attention to detail.
  • Ability to follow direction and then work independently with little supervision
  • Registered Nurse (RN), Registered Health Information Administrators (RHIA), or Registered Health Information Technicians (RHIT) preferred
  • Clinical experience (RN) desired
  • Previous Auditing experience preferred
  • Previous HEDIS auditing experience or medical legal review preferred
  • Previous experience with Electronic Health Records strongly preferred