HEDIS Quality Performance Specialist

WellSense Health Plan; Massachusetts; Presencial; USD 62 000 - 89 000; Tempo integral

Resumo da oferta

WellSense Health Plan in Massachusetts is seeking a Quality Performance Specialist to support HEDIS and quality reporting. You will review medical records across EMR systems, document findings using certified software, and ensure adherence to technical specifications.

The role emphasizes accuracy, data validation, and collaboration with provider partners to improve measure performance and quality initiatives within a nonprofit health plan.

Qualificações

• Bachelor’s degree in healthcare administration, nursing, public health, or related field, or equivalent combination of education and experience.
• Minimum 2 years of experience in healthcare quality or medical record abstraction.
• Knowledge and experience with HEDIS measures and abstraction methodologies.
• Clinical background or certification in medical coding/health information preferred.

Responsabilidades

• Performs medical record abstraction and data entry for NCQA HEDIS and other medical record–based regulatory audits.
• Maintains inter-rater reliability score ≥ 90% on required annual testing.
• Conducts medical record overreads to ensure accuracy and compliance with technical specifications.
• Abstracts records across EMR systems (EPIC, Allscripts, Cerner) for data accuracy and completeness.
• Collaborates with provider partners to ensure timely medical record retrieval and high procurement rates (≥ 95%).
• Supports training and education on HEDIS measures, data collection methods, and quality improvement principles.
• Identifies opportunities to improve abstraction workflows and contribute to quality performance initiatives.

Conhecimentos

HEDIS measures knowledge

Data abstraction

Quality reporting

Microsoft Office

Formação académica

Bachelor’s degree in healthcare administration

Ferramentas

Microsoft Office

Descrição da oferta de emprego

WellSense Health Plan in Massachusetts is seeking a Quality Performance Specialist to support HEDIS and quality reporting. You will review medical records across EMR systems, document findings using certified software, and ensure adherence to technical specifications.

The role emphasizes accuracy, data validation, and collaboration with provider partners to improve measure performance and quality initiatives within a nonprofit health plan.