Lead Overreader, HEDIS Abstraction / Quality Improvement (Remote)

About the position Responsibilities • Performs the lead role of the HEDIS medical record review overreader/auditor which includes ongoing review of records reviewed and data entered by the abstraction team during the annual HEDIS medical record review. • Acts as the subject matter expert for the team. • Provides feedback to providers on visit notes or feedback from the HEDIS audit. • Makes recommendations based off of the audit and chart review. • Assists Manager and Supervisor(s) in leading the training and mentoring of new staff. • Takes the lead role in training activities, utilizing standardized training materials and job aids. • Leads the team during HEDIS audits as well as ad hoc projects. • Leads scheduled meetings with the Abstraction team, National Training Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results. • Works with the Manager to monitor accuracy of abstracted records as required by specifications. • Assists the quality improvement staff with physician and member interventions and incentive efforts as needed through review of medical records documentation. • Assists in support of accreditation activities such as NCQA reviews, CAHPS and state audits by reviewing clinical documentation. • Provides data collection, presentations and report development support for quality improvement studies and performance improvement projects. Requirements • Bachelor's degree or equivalent experience. • 5 years experience in healthcare Quality/HEDIS specific to overreading. Nice-to-haves • At least 3 years of experience in the overread role. • 3+ years managed care experience. • Advanced knowledge of HEDIS and NCQA. Benefits • Competitive benefits and compensation package. Apply tot his job Apply To this Job