• Job Description

  Req#: R003464

  Company:

  AHI agilon health, inc.

  Job Posting Location :

  Remote - USA

  Job Title:

  HEDIS Abstractor and Overreader

  Job Description:

  Essential Job Functions:

  • Review and abstract clinical data from electronic medical records in alignment with HEDIS technical specifications
  • Perform overreads of abstracted medical records for accuracy, completeness and measure compliance
  • Demonstrate high level of proficiency in HEDIS measures and coding standards (including but not limited to ICD-10, CPT and CPTII) to close gaps in care
  • Collaborate with internal and external partners to resolve documentation discrepancies and provide recommendations for improvement
  • Support audit preparation and participate in internal quality reviews and training sessions
  • Manages all activities to meet health plan contractual and reporting timeframes
  • Identify trends in abstraction that may impact measure performance or audit readiness and proactively escalate to leadership

  Other Job Functions:

  • Other duties as assigned.

  Required Qualifications:

  Minimum Experience

  • Minimum of 2 years’ experience working with NCQA HEDIS programs and/or HEDIS abstraction in all measures
  • Proficiency in EMR platforms (i.e., Epic, Cerner) and abstraction tools
  • Familiarity with Medicare Advantage lines of business and Stars Measures
  • Familiarity with supplemental data processes and quality data integration

  Education & Licensure

  • High School Diploma or equivalent required

  Skills and Abilities:

  • Ability to be a team player and exercise initiative in responding to team members or Sr. Manager.
  • Thorough understanding of medical record documentation and medical terminology
  • High level of attention to detail and ability to follow direction on project deadlines
  • Ability to work independently
  • Strong language skills in English speaking and understanding
  • Ability to meet high productivity requirements and Interrater Reliability standards
  • Strong Excel skills
  • Ability to interpret compliance vs non-compliance on health plan gap file use to direct abstraction efforts.
  • Ability to apply deep level of measure understanding to legal medical records
  • Strong Adobe skills (including saving records in PDF format and annotation)
  • Ability to interpret large data files for needed abstraction
  • Deep level of ability to recognize medical records that are not complete or are missing needed data points in overreading
  • Ability to report clearly on both positive or negative findings and apply possible solutions on Team calls

  Location:

  Remote - MA

  Pay Range:

  $24.00 - $28.70

  Salary range shown is a guideline. Individual compensation packages can vary based on factors unique to each candidate, such as skill set, experience, and qualifications.

• About the company

  agilon health is built for physicians by physicians, as the patient-physician relationship is the cornerstone of care. We allow primary care physicians to take the long view of their relationships with patients, and to be confident in the long-term fin...

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