HEDIS Nurse in Philadelphia, PA

HEDIS Data Reviewer Location: [Philadelphia/Hybrid] Temporary Position - Contract Through April Overview Under the direction of the Manager of Medical Record Review Operations, the HEDIS Data Reviewer supports quality reporting initiatives, including annual HEDIS and State EQRO reporting. This role is responsible for medical record abstraction, overread, and audit activities, ensuring accuracy, compliance, and timely data submission in accordance with technical specifications. Key Responsibilities • Coordinate medical record identification, collection, and review activities with provider offices. • Perform structured medical record abstraction and overread to determine compliance with HEDIS and State performance measures. • Accurately enter chart audit results into designated databases and abstraction tools. • Maintain expert knowledge of HEDIS and State measure requirements and technical specifications. • Provide feedback on records that do not meet HEDIS or State criteria within live software environments. • Support providers with clinical and administrative inquiries as directed. • Meet established productivity standards for chart/chase completion. • Maintain a minimum abstraction proficiency rate of 98% through accurate interpretation of medical records, including progress notes, consultations, medication records, treatment plans, and patient histories. • Assist with medical record collection by making outreach calls, sending faxes or letters, and submitting chart retrieval requests. • Participate in additional projects and initiatives as assigned. Qualifications & Skills • 3–5 years of experience working with HEDIS data, including chart review and collection. • Experience with HEDIS, QRS, or STARs reporting. • Strong understanding of current HEDIS Technical Specifications. • Knowledge of the HEDIS audit process, including PSV, CSV, and MRRV. • Familiarity with medical terminology and clinical documentation related to: • Diabetic labs • HPV testing • Preventive health screenings • Immunizations and well-care visits (children, adults, and pregnant women) • Experience using medical record abstraction tools; willingness to learn new systems. • Proficiency in Microsoft Excel, Word, PowerPoint, and Outlook. • Background in pediatric, maternity, diabetic, or provider office settings preferred. • Familiarity with the Cancer Registry and Bright Futures guidelines a plus. • Strong written and verbal communication skills with excellent attention to detail. • Ability to work independently, manage deadlines, and perform effectively in a fast-paced environment. Why Join Us • Make a direct impact on healthcare quality and compliance initiatives • Collaborative, mission-driven environment • Opportunity to deepen expertise in HEDIS and quality reporting