HEDIS Abstractor, Performance Programs in Orange at Prospect Medical Systems

Date Posted: 8/30/2020

Job Snapshot

  • Employee Type:
  • Location:
    600 City Parkway West
  • Experience:
    Not Specified
  • Date Posted:
  • Job ID:

Job Description

HEDIS Abstractor - Performance Programs

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

Under direction of Performance Program’s leadership team, the P4P/STAR/HEDIS Abstractor will provide timely and accurate medical record review, enter data findings into abstraction tool, review/over-read data entry/provide feedback, identify chase opportunities, facilitate retrieval of medical records and track progress of efforts.  Must exhibit knowledge and competence of NCQA guidelines, HEDIS Technical Specifications and HEDIS Measure Detail while adhering to PP Dept Policies and Procedures. The abstraction team will meet chart abstraction productivity standards as well as minimum over read standards. 

Job Responsibilities/Duties

  • Coordination and preparation of the HEDIS medical record review project which includes but not limited to ongoing medical records review, auditing of medical records submitted by providers, onsite visits for provider feedback, training on proper documentation.
  • Accurately enter 95% of data into abstraction tool and/or ICE files
  • Collaborate with Quality Care Coordinators in Stars/HEDIS related activities/MR retrieval
  • Ensure privacy and security of Protected Health Information, (PHI) in compliance with HIPAA
  • Read and adhere to NCQA HEDIS Technical Specifications and annual updates
  • Communicate changes, create, update and maintain HEDIS training materials
  • Follow Policy and Procedures for naming and saving records appropriately
  • Assists Manager and Supervisor(s) in training and takes a lead role in these activities, utilizing the standardized training materials and job aids.
  • Communicate to supervisors any challenges, technical issues, or inability to meet deadlines
  • Responsible for maintaining Stars/HEDIS Calendar events and completing assigned tasks on time
  • Visit provider offices as needed for in person training on HEDIS measures and how to abstract/close care gaps in HEDIS engine
  • Responsible for reporting and attempting to resolve Heat Ticket issues internally or with vendor
  • Works with NCQA to monitor accuracy of abstracted records as required by specifications


Minimum Education: Bachelor's Degree or certified coder or equivalent experience highly preferred

Minimum Experience:  Minimum three (3) years of experience in healthcare with minimum 2 years coding and medical record abstraction experience. One (1) year managed care experience, RN or LVN valid license preferred.

Req. Certification/Licensure: None

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

How to Apply

To apply for this role, or search our other openings, please visit   https://prospectmedicalsystems.com/about-us/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Keywords: HEDIS, NCQA, HIPPA, Managed Care, Hospital