Remote HEDIS Quality Performance Analyst

WellSense Health Plan; United States; Teletrabalho; USD 62 000 - 89 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Remote work

Competitive salary

Excellent benefits

Resumo da oferta

WellSense Health Plan seeks a Quality Performance Specialist to support HEDIS and quality reporting, ensuring accurate medical record abstraction and data validation across multiple EMR systems. The role emphasizes driving data quality for regulatory audits and quality improvement initiatives.

Candidates will review records across provider EMRs, participate in training, and contribute to broader quality initiatives while maintaining high IRR scores and collaborating with provider partners.

Qualificações

• Bachelor's degree in healthcare administration, Nursing, Public Health, or related field, or an equivalent combination of education and experience.
• Minimum 2 years of experience in healthcare quality, medical record abstraction, or managed care.
• Knowledge and experience with HEDIS measures and abstraction methodologies.

Responsabilidades

• Performs medical record abstraction and data entry for NCQA HEDIS and other medical record-based regulatory audits.
• Achieves and maintains an inter-rater reliability (IRR) score of 90% on required annual testing.
• Conducts medical record overreads to ensure accuracy, consistency, and compliance with technical specifications.
• Access, navigate and abstract medical records across EMR systems (e.g., EPIC, Allscripts, Cerner).
• Cultivates strong relationships with provider partners to ensure timely and accurate medical record retrieval.
• Leverages health plan systems to research member and claims data, validate service information, and ensure records are sourced from the correct provider location.
• Collaborates with internal teams and provider offices to ensure timely procurement and review of medical records, supporting a chart procurement rate 95%.
• Assists with training and education to staff on HEDIS measures, diagnosis capturing, data collection methods and quality improvement principles.
• Identify opportunities to improve abstraction workflows and overall quality performance.
• Participates in cross-functional projects and workgroups to support measure performance improvement and quality improvement initiatives.

Conhecimentos

Problem solving

Attention to detail

MS Office

HEDIS software

EMR system knowledge

Communication skills

Team collaboration

Formação académica

Bachelor's degree in healthcare administration

Ferramentas

EPIC

Allscripts

Cerner

HEDIS software

Descrição da oferta de emprego

WellSense Health Plan seeks a Quality Performance Specialist to support HEDIS and quality reporting, ensuring accurate medical record abstraction and data validation across multiple EMR systems. The role emphasizes driving data quality for regulatory audits and quality improvement initiatives.

Candidates will review records across provider EMRs, participate in training, and contribute to broader quality initiatives while maintaining high IRR scores and collaborating with provider partners.