JOB SUMMARY

Under the direction of the Director of Quality and Senior Manager of Quality/Medicare Stars, the HEDIS Abstractor is responsible for year-round HEDIS medical record abstraction/education/strategy support in conjunction with the plans' Quality and Medicare Stars programs/initiatives.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This position must be able to:

• Performs the Quality Medical Record work plan, helps coordinate, and provides HEDIS medical record review, including but not limited to data retrieval/collection, data entry, tracking, auditing, and reporting on medical records submitted by providers
• Assesses for adherence to the NCQA HEDIS specifications to determine if preventative and diagnostic services have been correctly performed and captured for our plan’s Medicare population.
• Utilizes resources and reference materials (e.g., online sources, manuals) to identify appropriate clinical information based on HEDIS and Medicare guidelines.
• May also help create educational materials for HEDIS.
• Performs other duties as assigned.

**** EDUCATION AND EXPERIENCE

Education:

• High School diploma, GED

Required Experience:

• Two (2) or more years of Medicare Advantage HEDIS experience
• One (1) or more years of HEDIS Medical Record Abstractor experience
• Experience working with Electronic Medical Records and Electronic Health Records.
• Typing Speed minimum fifty words per minute
• Proficient in Microsoft Outlook, Teams Word, MS Excel (Level 2 – Intermediate)

Preferred Experience:

• Bachelor’s Degree or four (4) or more years of equivalent work experience

KNOWLEDGE, SKILLS, AND ABILITIES

Required:

• Knowledge of applicable CMS Medicare Advantage and NCQA HEDIS requirements for the Medicare population.
• Strong in the following competencies:
  • Decision-making/Judgment
  • Problem-solving/Analysis
  • Communication
  • Creativity/Innovation
  • Ability to work independently

Preferred:

• Knowledge of HEDIS requirements
• Strong project management skills

PHYSICAL REQUIREMENTS

• Exerting up to 10 pounds of force occasionally (up to 1/3 of the time) and;
• A negligible amount of force frequently (1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body.
• Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

ABOUT HEALTHTEAM ADVANTAGE

HealthTeam Advantage is an equal-opportunity employer. All applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

HealthTeam Advantage (HTA), a Greensboro-based health insurance company, offers Medicare Advantage plans to eligible Medicare beneficiaries in 11 North Carolina counties. HTA has been named a “Best Places to Work” finalist three times by Triad Business Journal. To learn more, visit HealthTeamAdvantage.com.