HEDIS Abstractor- TRC

Pride Health is seeking experienced HEDIS Abstraction/Overreaders for the 2024-2025 HEDIS season.

Job Title: HEDIS Abstraction/Overreaders

Location:

· 100% Remote

· Reliable high-speed internet access required

· Designated workplace inside home

Work Hours:

· Full-time, 8:00 AM – 5:00 PM (your time zone)

· Ability to commit to the entire January–May assignment with minimal absences

Hourly Pay: $36/hour to $42/hour based on experience

Position Overview:
As a Clinical Quality Analyst, you will play a crucial role in supporting our Quality Optimization and Insights (QOI) team by overseeing non-compliant members in HEDIS® quality measures. This position involves thorough medical record reviews, data validation, and ensuring compliance with established quality standards. Your expertise will contribute to achieving exceptional performance that exceeds the expectations of our constituents, customers, and members.

Key Responsibilities:

· Perform medical record reviews for HEDIS® and HEDIS®-like measures to verify clinical data elements abstracted by vendors, ensuring compliance with production goals.

· Conduct over-reads of medical records to validate accuracy and adherence to quality measures.

· Maintain HIPAA standards and confidentiality of protected health information; report critical incidents immediately.

· Communicate any questions or concerns to your Contractor Supervisor or assigned Specialist promptly.

· Attend team meetings to share insights and updates related to clinical reviews and compliance.

· Successfully complete HEDIS® technical specification training and testing with a passing score of 95% or greater.

· Utilize HEDIS® software effectively following training completion.

· Perform additional duties as assigned to support the team’s objectives.

Required Skills and Attributes:

· HEDIS experience with specific experience with any of the following quality measures: CBP, GSD, and TRC and COA.Experience with LTSS, FFR, and FFS a plus.

· Overread experience REQUIRED.

· Research-oriented with excellent proofreading skills.

· Strong critical thinking and analytical abilities.

· Exceptional time management and prioritization skills.

· Effective communication skills.

· Proficiency in Microsoft Office applications, including Word, Excel, Adobe, and PowerPoint.

· Self-starter with a results-driven approach to work.

· Intermediate proficiency in Microsoft Office applications.

“Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, , legal support, auto ,home insurance, pet insurance, and employee discounts with preferred vendors.

About Pride Health

Pride Health is Pride Global’ s healthcare staffing branch, providing recruitment solutions for healthcare professionals and the industry at large since 2010.

As a minority-owned business that delivers exceptional service to its clients and candidates by capitalizing on diverse recruiting, account management, and staffing backgrounds, Pride Health’s expert team provides tailored and swift sourcing solutions to help connect healthcare talent with their dream jobs. Our personalized approach within the industry shines through as we continue cultivating honest and open relationships with our network of healthcare professionals, creating an unparalleled environment of trust and loyalty.

Equal Employment Opportunity Statement

As a certified minority-owned business, Pride Global and its affiliates – including Russell Tobin, Pride Health, and Pride Now – are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.

Job Types: Full-time, Contract

Pay: $35.00 – $42.00 per hour

Work Location: Remote