HEDIS Reviewer

in Jackson
, MS
Reference: 19-02647

Key Duties and Responsibilities: 

  • Collect data for ambulatory medical record reviews and compliance with provider preventive health and chronic disease outcome improvement interventions
  • Prepare reports and quality improvement studies in an accurate, concise and timely fashion
  • Conduct internal auditing for compliance with regulatory and accreditation standards, and monitor and provide consultation to departments to correct deficiencies
  • Communicate with external data sources as needed to gather data necessary to measure identified outcomes
  • Provide communication such as newsletter articles, member education, outreach interventions and provider education
  • Collect and summarize performance data and identify opportunities for provider improvement
  • Participate in site visit preparation and execution by regulatory and accreditation agencies (State agencies, CMS, AAAHC, URAC, NCQA,EQRO)
  • Pursue methods to ensure receipt of data required for trending and reporting of various QI work plan metrics
  • Assist in activities to prioritize clinical and service improvement initiatives
  • Ensure that documentation produced and/or processed complies with state regulations and/or accrediting body requirements
  • Ensure assigned contract/regulatory report content is accurate and that submission adheres to deadline
  • Perform other duties as assigned

Education Level:

  • A Bachelor’s degree in a related field or equivalent work experience

Experience Level:

  • 3+ years of experience in HEDIS and/or quality improvement
  • Experience in a managed care and health services environment
  • Experience in data collection and data entry

Skill Sets:

  • Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
  • Demonstrated interpersonal/verbal communication skills
  • Ability to multi-task
  • Ability to work in a fast-paced environment with changing priorities
  • Ability to implement process improvements
  • Ability to effectively present information and respond to questions from families, members, and providers


  • Microsoft Excel
  • Microsoft Access
  • Microsoft PowerPoint
  • Microsoft Outlook