HEDIS Abstractor

What You'll Do

• Perform medical record abstraction and chart review for HEDIS and quality improvement initiatives
• Identify and close HEDIS care gaps through accurate review and documentation of clinical records
• Interpret and apply HEDIS measure specifications, coding guidelines, and NCQA technical requirement
• Review and validate data for accuracy, completeness, and compliance with HEDIS standards
• Conduct quality assurance (QA) reviews of abstracted records and audit findings
• Collaborate with providers, clinics, health plans, and internal departments to obtain required medical documentation
• Partner with external audit vendors to support medical record retrieval, validation and audit readiness activities
• Analyze abstraction results and identify trends, discrepancies, or opportunities for process improvement
• Ensure compliance with HIPAA and all applicable privacy and confidentiality regulations
• Maintain productivity and accuracy standards while meeting project deadlines
• Support continuous quality improvement initiatives and assist with reporting activities as needed
• Other duties as assigned

Qualifications

• High school diploma or equivalent required; associate or bachelor’s degree in healthcare-related field
• Have at least 2 year of HEDIS abstraction or medical record review experience
• Strong knowledge of NCQA HEDIS measure specifications and quality improvement processes
• Proficiency with ICD-10, CPT, HCPCS, and other clinical coding systems
• Experience performing QA reviews and supporting HEDIS audit activities
• Familiarity with EMR/EHR systems and healthcare documentation workflows
• Strong analytical, organizational, and problem-solving skills
• Excellent attention to detail and accuracy
• Ability to work independently and manage multiple priorities in a fast-paced environment
• Strong written and verbal communication skills

• Certified Professional Coder (CPC), RHIT, RHIA, LVN/LPN, RN, or other healthcare-related certification 
• Experience working with health plans, managed care organizations, or quality improvement departments
• Knowledge of CMS Stars, risk adjustment, and population health initiatives strongly preferred

Environmental Job Requirements and Working Conditions

• Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr, Monterey Park CA 91754. 
• This role will require travelling locally up to 35% of the time.
• The annual total compensation target pay range for this role is: $27.00 - $33.00 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.