HEDIS Over-Reader & Abstraction Quality Auditor

W3R Consulting; New Mexico; On-site; USD 42,000 - 64,000; Full time

Job summary

W3R Consulting seeks a detail-oriented HEDIS reviewer to support the HEDIS Effectiveness Data and Information Set project under supervision. You will review medical records, ensure accuracy and adherence to NCQA guidelines, and maintain strict confidentiality.

The role requires knowledge of medical terminology, data entry skills, and effective communication. Proficiency in Word/Excel and Lotus Notes is expected; auditing experience is a plus.

Qualifications

• Clinical experience and ability to follow NCQA/HEDIS guidelines.
• Accurate data entry and chart review skills.
• Experience with HIPAA/patient confidentiality.

Responsibilities

• Over-read medical record abstractions daily per HEDIS specs and BCBSIL training.
• Complete IRR/over-read tool with comments; re-review similar errors as needed.
• Identify and report abstraction errors; provide measure re-education.
• Use software to support HEDIS operations and update chase statuses.
• Meet with HEDIS Coordinator/QI to discuss efforts and open issues.
• Maintain productivity as directed by supervisors.
• Ensure HIPAA compliance and confidentiality.
• Perform other duties as assigned.

Skills

Medical terminology knowledge

Data entry

Clear written/verbal communication

PC proficiency: Word, Excel, Lotus Not

Auditing experience (preferred)

Tools

Word

Excel

Lotus Notes

Job description

W3R Consulting seeks a detail-oriented HEDIS reviewer to support the HEDIS Effectiveness Data and Information Set project under supervision. You will review medical records, ensure accuracy and adherence to NCQA guidelines, and maintain strict confidentiality.

The role requires knowledge of medical terminology, data entry skills, and effective communication. Proficiency in Word/Excel and Lotus Notes is expected; auditing experience is a plus.