Job Profile Summary
Position Purpose: Lead data collection and abstraction for company quality measures, including HEDIS, CMS, CHIPRA and/or any other custom measurements.
Education/Experience: Associate’s degree in related field or equivalent experience. Bachelor degree preferred. 4+ years of nursing, medical assistant, medical coding or data management experience. Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards) preferred. Advanced knowledge of Microsoft Applications, including Excel and Access.
Licenses/Certifications: Current state’s RN or LPN license preferred.
Responsibilities
• Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards
• Review medical records and abstract data for HEDIS and other measure sets in compliance with standards
• Track and report on issues and outcomes related to abstractions and over-reads
• Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required
• Perform other quality initiatives as necessary
EEO:
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
==================================
"Position Purpose:
Lead data collection and abstraction for company quality measures, including HEDIS, CMS, CHIPRA and/or any other custom measurements.
Education/Experience:
Associate’s degree in related field or equivalent experience. Bachelor degree preferred. 4+ years of nursing, medical assistant, medical coding or data management experience. Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards) preferred.
Licenses/Certifications: Current state’s RN or LPN license preferred
"Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards
Review medical records and abstract data for HEDIS and other measure sets in compliance with standards
Track and report on issues and outcomes related to abstractions and over-reads
Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required
Perform other quality initiatives as necessary
Performs other duties as assigned
Complies with all policies and standards"
Story Behind the Need
- What is the purpose of this team?
- What is driving this need? (ex. Backfill for FTE or CW, new project, business growth)
- Describe the surrounding team (team culture, work environment, etc.) & key projects.
- Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
What is the purpose of this team?
The purpose of the HEDIS contractor team is to support medical record retrieval and data collection activities in preparation for HEDIS season. By bringing these resources on ahead of the official season, we are able to get a head start on closing care gaps, ensuring records are obtained, documented, and uploaded accurately and timely to support abstraction and reporting needs.
Describe the surrounding team (team culture, work environment, etc.) & key projects.
The HEDIS contractors work closely with the NC Quality team in a highly collaborative and supportive environment. The culture is fast-paced but team-oriented, with clear processes, training, and ongoing guidance provided to ensure contractors are set up for success. Contractors interact with provider offices daily, handling a high volume of calls and faxes, and documenting each interaction thoroughly. Key projects include contacting providers to obtain medical records, labeling and uploading records into the abstraction database, and assisting the HEDIS team in ensuring data is available for quality measure reporting.
Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
This request is part of our annual HEDIS preparation process. Each year, we onboard contractors in advance of the season to make sure we are fully staffed and trained by the time record collection peaks. At this time, no additional hiring is projected outside of this seasonal need.
Typical Day in the Role
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
Walk me through the day to day responsibilities of this the role and a description of the project (Outside of Workday JD):
- Assist with retrieval of medical records.
- Works with the HEDIS Ops and Risk Adjustment teams to collect member records by contacting providers and placing collected records into database utilized
- Required to handle a high-volume (40-50 per day) of inbound and outbound calls with provider offices
- Continued follow up on requested medical records until obtained
- Excellent documentation of research and contact information
- Labeling records with appropriate naming convention
- Loading medical records to abstraction database
Describe the performance expectations/metrics for this individual and their team:
- TBD, but likely 40 – 50 calls/faxes per day
Candidate Requirements
Education/Certification
Required: Required: Associate Degree RN – NC or Compact state license
Preferred: Bachelor degree preferred
Licensure
Required: LPN - NC
Preferred: RN – NC or Compact state license
Years of experience required:
• Minimum 4 years of nursing experience (active RN required)
• At least 1 year of experience in medical record review, quality improvement, or related administrative clinical work, call center
Disqualifiers:
• No active RN/LPN license or lapsed/expired license
• Lack of experience with medical record systems or electronic documentation
• Inability to commit to full-time schedule during the contract period
• Limited computer proficiency (unable to navigate Excel or complete required computer testing)
• Refusal or inability to be on camera for required training and testing
Additional qualities to look for:
• Strong organizational skills and attention to detail
• Ability to handle a high-volume workload under tight timelines
• Professional communication and follow-up skills with provider offices
• Reliability and accountability in meeting daily call/fax and documentation expectations
- Top 3 must-have hard skills stack-ranked by importance
1
Medical record retrieval and documentation accuracy (critical for data integrity)
2
Strong computer skills (Excel, medical record software, and ability to pass computer testing)
3
Effective provider communication (handling high call/fax volume with professionalism)
Candidate Review & Selection
- Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
Projected Manager Candidate Review Date:
Within 24 hours post shortlisting
Type of Interviews:
Team MS Teams, It is critical that candidates are on camera and using a laptop or desktop, as there will be a computer test in the interview.
Required Testing or Assessment (by Vendor):
Agency perform Computer literacy test (excel) – please attach results to the resume
Manager will be reperforming the computer test in interview
Next Steps
- Do you have any upcoming PTO?
N/A
- Colleagues to cc/delegate
