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Hedis Chart Reviewer Jobs in Indiana (NOW HIRING)

Dupont Hospital

RN Pre/Post/PACU FT Evenings

Fort Wayne, IN · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

Participates in audits, chart reviews, and compliance checks to ensure adherence to standards of practice and regulatory requirements. * Demonstrates responsible decision-making in planning ...

STI

ADDM Abstractor

Indianapolis, IN · On-site

... chart abstractions on children reported to the ADDM network. 1. 2. Actively collaborate with ADDM ... Work is reviewed for general technical accuracy, conclusions, and compliance with ADDM Network ...

All JobsHedis Chart Reviewer JobsHedis Chart Reviewer Jobs in Indiana

Hedis Chart Reviewer information

What is a HEDIS chart reviewer?

A HEDIS Chart Reviewer is a healthcare professional responsible for reviewing medical records and charts to collect data for the Healthcare Effectiveness Data and Information Set (HEDIS). This data is used by health plans to measure performance on various dimensions of care and service. Reviewers examine patient charts to verify the accuracy of reported data, identify gaps in care, and ensure compliance with HEDIS guidelines. Their work helps health organizations improve patient outcomes and meet regulatory requirements.

What is the difference between Hedis Chart Reviewer vs Hedis Data Abstractor?

AspectHedis Chart ReviewerHedis Data Abstractor
Required CredentialsMedical coding certification, healthcare experienceMedical coding certification, healthcare experience
Work EnvironmentHealthcare facilities, insurance companiesHealthcare facilities, insurance companies
Employer & Industry UsageInsurance providers, healthcare organizationsInsurance providers, healthcare organizations
Common Search & ComparisonYesYes

The main difference between a Hedis Chart Reviewer and a Hedis Data Abstractor lies in their focus. The Hedis Chart Reviewer primarily reviews patient charts for compliance and accuracy, while the Hedis Data Abstractor extracts data from medical records for reporting purposes. Both roles require similar credentials and are used within healthcare and insurance industries, but their specific responsibilities differ based on the review versus data abstraction tasks.

How does a HEDIS chart reviewer typically collaborate with healthcare providers and medical records staff during the data collection process?

As a HEDIS Chart Reviewer, you will frequently interact with healthcare providers and medical records staff to request, access, and clarify patient documentation needed for accurate data abstraction. Building professional relationships and maintaining clear communication is key to efficiently obtaining the necessary records while respecting privacy regulations. Reviewers often coordinate schedules for on-site visits or remote access, and must be able to explain HEDIS requirements to ensure all relevant information is collected for quality reporting. This collaborative approach helps streamline the review process and ensures compliance with both healthcare standards and organizational protocols.

What are the key skills and qualifications needed to thrive as a HEDIS chart reviewer, and why are they important?

To thrive as a HEDIS Chart Reviewer, you need strong knowledge of medical terminology, clinical documentation, and HEDIS measures, typically supported by a background in nursing, health information management, or a related field. Familiarity with electronic medical record (EMR) systems, data abstraction tools, and sometimes specific certifications like RHIT or RN are commonly required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for success in this role. These skills ensure accurate data collection and reporting, which directly supports quality improvement and compliance in healthcare organizations.
What are popular job titles related to Hedis Chart Reviewer jobs in Indiana? For Hedis Chart Reviewer jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Hedis Chart Reviewer jobs in Indiana look for? The top searched job categories for Hedis Chart Reviewer jobs in Indiana are:
Hedis Chart Reviewer jobs near you

Clinical Quality Specialist

SIHO Insurance Services

Indianapolis, IN • On-site, Remote

$35 - $46.50/hr

Full-time

Re-posted 24 days ago

Job description

Job Title: Clinical Quality Specialist

Reports to: Director, Medical Management

The Clinical Quality Specialist supports the Clinical Quality Nurse in overseeing the HEDIS quality collection, submission, reporting, and auditing as well as assists with education to support the MyTruAdvantage line of business.

 

Key Responsibilities:

 

  • Knowledge of current HEDIS guidance, hybrid measure reporting, and measure compliance requirements.
  • Collaborate with Clinical Quality Nurse and internal data analyst to oversee HEDIS quality gap distribution to health partners and member providers for HEDIS clinical data collection.
  • Participate in communication with health partners regarding process of clinical document submission, annual education on applicable HEDIS measures, and cadence of reporting.
  • Help identify opportunities for improved or expanded HEDIS data collection.
  • Participate in internal chart chasing efforts.
  • Assure proper internal secure storage of HEDIS data collected from external providers.
  • Participate in Medical Record Review clinical submissions processes, assuring accuracy and completeness.
  • Support outreach efforts to external providers to collect clinicals needed for reporting.
  • Assist with maintaining all HEDIS related guidelines, policy & procedures, and auditing documents necessary for successful annual HEDIS audits.
  • Active participant in any external HEDIS audits performed as needed.
  • Support internal Chronic Care Improvement Program initiatives as needed.
  • Participate in internal or external process improvement efforts that support the quality improvement and collection efforts necessary for the Medicare Advantage or commercial lines of business. (Accurate provider attributions, training of health partners, training of new internal staff etc.)

Minimum Skills Requirement:

  • CMA or experience in clinical documentation review preferred.
  • Experience in working for or with HEDIS data collection and reporting preferred.
  • Proficiency in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint).
  • Experience with electronic medical records and using online tools.
  • Ability to communicate professionally with physicians and office staff to facilitate organizational initiatives.
  • Willingness to obtain applicable HEDIS certifications deemed appropriate for position.

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.