Remote HEDIS Quality Performance Specialist

WellSense Health Plan; Boston (MA); Remoto; USD 62.000 - 89.000; Tempo integral

Benefícios oferecidos por esta vaga

Full-time remote work

Competitive salaries

Excellent benefits

Resumo da vaga

WellSense Health Plan is seeking a Quality Performance Specialist to support HEDIS and quality reporting initiatives. You will review medical records across EMR systems, ensure data accuracy, document findings using certified software, and support training and quality improvement efforts.

With at least 2 years in healthcare quality or medical record abstraction, you will collaborate with provider partners and internal teams to ensure timely record retrieval and compliance with specifications,

Qualificações

• Minimum 2 years of experience in healthcare quality, medical record abstraction, or managed care.
• Knowledge and experience with HEDIS measures and abstraction methodologies.
• Prior experience supporting quality reporting, audits, and supplemental data submissions is desirable.

Responsabilidades

• Performs medical record abstraction and data entry for NCQA HEDIS and other audits.
• Aims for inter-rater reliability score of ≥90% on annual testing.
• Conducts medical record overreads to ensure accuracy and compliance with specs.
• Access and abstract records across EMR systems (EPIC, Allscripts, Cerner) for data accuracy.
• Collaborates with provider partners to ensure timely and accurate record retrieval.
• Uses health plan systems to verify member and claims data and source records from the correct location.
• Supports chart procurement rates ≥95% through collaboration with teams and offices.
• Assists with training staff on HEDIS measures and data collection methods.
• Identifies opportunities to improve abstraction workflows and overall quality.
• Participates in cross-functional projects to improve measure performance and quality.

Conhecimentos

Medical record abstraction

HEDIS measures

Data validation

Training support

Formação

Bachelor’s degree in healthcare administration, Nursing, Public Health, or related field

Ferramentas

EPIC

Allscripts

Cerner

Microsoft Office

Descrição da vaga

WellSense Health Plan is seeking a Quality Performance Specialist to support HEDIS and quality reporting initiatives. You will review medical records across EMR systems, ensure data accuracy, document findings using certified software, and support training and quality improvement efforts.

With at least 2 years in healthcare quality or medical record abstraction, you will collaborate with provider partners and internal teams to ensure timely record retrieval and compliance with specifications,