What Does a HEDIS Coordinator Do?
A HEDIS coordinator manages the end-to-end process of collecting, validating, and reporting healthcare quality data in alignment with HEDIS standards. HEDIS, the Healthcare Effectiveness Data and Information Set, is a widely used performance measurement tool administered by the NCQA (National Committee for Quality Assurance). Coordinators play a vital role in retrieving clinical and claims data, managing abstraction processes, and supporting compliance with accreditation requirements. They often collaborate with data analysts, providers, and compliance teams to ensure complete, accurate reporting for performance scoring and regulatory deadlines.
Their work directly impacts an organization’s quality scores, reimbursement rates, and public performance metrics. These professionals help track preventive care, chronic disease management, and service utilization benchmarks. Given the high stakes involved, the role requires precision, attention to detail, and fluency in healthcare systems and reporting tools. Coordinators must remain current on evolving NCQA specifications and be prepared to assist in audits or external reviews. The accuracy and efficiency of their work can influence both patient outcomes and organizational success.
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HEDIS Coordinator Core Responsibilities
- Coordinate the full HEDIS data collection and submission process for the organization
- Abstract medical records and claims data to validate performance against specific HEDIS measures
- Maintain and track compliance with NCQA reporting timelines and submission protocols
- Contact provider offices to request patient records and verify data completeness
- Monitor and resolve data gaps through internal and external outreach
- Collaborate with internal quality, clinical, and data analytics teams
- Conduct preliminary chart reviews and identify inaccuracies or deficiencies
- Prepare documentation for HEDIS audit readiness and ensure compliance with NCQA specifications
- Assist in quality improvement initiatives based on performance trends
- Stay current with annual HEDIS measure updates and regulatory changes
Required Skills and Qualifications
Hard skills
- Knowledge of HEDIS, NCQA reporting standards, and CMS quality initiatives
- Experience with medical record abstraction and claims data review
- Proficiency in EHR platforms and quality data management tools (e.g., QSI, Cotiviti, or Inovalon)
- Familiarity with ICD-10, CPT, and HCPCS coding systems
- Ability to manage and maintain large datasets accurately
Soft skills
- High attention to detail and organizational accuracy
- Clear written and verbal communication with providers and internal teams
- Time management in deadline-driven environments
- Analytical thinking and problem resolution
- Professionalism in handling sensitive medical and patient data
Education
- Associate’s degree in health information management, nursing, or a related field required
- Bachelor’s degree preferred
Certifications
- RHIT (Registered Health Information Technician) or RHIA preferred
- HEDIS Abstraction Certification or NCQA-compliant training strongly recommended
- HIPAA compliance certification required
Preferred Qualifications
- Prior experience supporting HEDIS reporting for a managed care organization or health plan
- Familiarity with Medicaid and Medicare Advantage performance measures
- Previous work in a hybrid abstraction model (remote + onsite)
- Ability to interpret performance trends and assist in quality improvement strategies
- Bilingual communication skills (especially Spanish) are a plus
National Average Salary
HEDIS coordinator salaries vary by experience, industry, organization size, and geography. Click below to explore salaries by local market.
The average national salary for a HEDIS Coordinator is:
$69,540
Sample Job Description Templates for HEDIS Coordinators
Entry-Level HEDIS Coordinator
Position Overview
We are looking for an Entry-Level HEDIS Coordinator to support quality reporting operations during the annual HEDIS cycle. This is a foundational role with on-the-job training provided in chart review, provider outreach, and NCQA measure guidelines. Ideal for recent graduates or healthcare professionals transitioning into quality and compliance work.
Responsibilities
- Assist in retrieving medical records for HEDIS data collection
- Perform basic chart reviews under supervision
- Help track provider responses and monitor documentation completeness
- Enter data into abstraction and tracking systems
- Maintain secure handling of PHI throughout the data collection process
Requirements
Hard skills
- Familiarity with medical records and basic understanding of clinical documentation
- Working knowledge of Microsoft Excel and EHR navigation
- Strong data entry accuracy
Soft skills
- Attention to detail
- Willingness to learn and adapt to technical standards
- Strong follow-up and organizational habits
Education
- High school diploma required
- Associate’s degree in health information or healthcare administration preferred
Certifications
- HIPAA certification required
Preferred Qualifications
- Experience in a medical records or clerical healthcare role
- Interest in quality assurance or compliance careers
- Strong interest in healthcare analytics
Mid-Level HEDIS Coordinator
Position Overview
We are hiring a Mid-Level HEDIS Coordinator with 2–5 years of experience in HEDIS data abstraction and provider coordination. This role independently manages chart review cycles, identifies compliance gaps, and contributes to improvement planning across multiple health plans.
Responsibilities
- Perform advanced chart abstraction and validation for multiple HEDIS measures
- Coordinate provider record retrieval and conduct follow-ups
- Interpret NCQA updates and incorporate them into data collection workflows
- Maintain audit trails for regulatory readiness
- Identify trends in measure performance and flag potential issues
Requirements
Hard skills
- Strong command of HEDIS measures, ICD-10, CPT coding, and abstraction processes
- Experience using abstraction platforms like Inovalon or Cotiviti
- Data analysis proficiency to detect outliers or inaccuracies
Soft skills
- Self-direction in managing workload and deadlines
- Clear reporting and escalation practices
- Critical thinking in complex chart review situations
Education
- Associate’s degree required; bachelor’s preferred
Certifications
- HIPAA and HEDIS abstraction training required
- RHIT or RHIA preferred
Preferred Qualifications
- Prior experience across Medicaid, Medicare, or commercial HEDIS programs
- Familiarity with quality improvement interventions tied to HEDIS
Senior HEDIS Coordinator
Position Overview
We are seeking a Senior-Level HEDIS Coordinator to lead complex abstraction efforts and oversee the accuracy of reporting across HEDIS cycles. This role provides mentorship to junior staff, ensures audit readiness, and works closely with quality improvement leadership on strategy and analysis.
Responsibilities
- Lead abstraction projects and validate accuracy of submissions
- Train and mentor junior HEDIS staff on compliance standards
- Liaise with IT, data, and clinical teams to optimize workflows
- Serve as a subject matter expert on NCQA measure changes
- Conduct mock audits and develop documentation for external review
Requirements
Hard skills
- Mastery of HEDIS abstraction, NCQA compliance, and data quality controls
- Experience in managing end-to-end abstraction operations
- Skilled in health data analytics and audit preparation
Soft skills
- Leadership and training capabilities
- Analytical mindset with a proactive approach to problem-solving
- Confidence in presenting findings to leadership
Education
- Bachelor’s degree required
Certifications
- RHIT, RHIA, or HEDIS certification required
- HIPAA certification required
Preferred Qualifications
- Prior experience managing abstraction for multiple health plans
- Background in process improvement or lean methodology
- Strong experience supporting NCQA accreditation reviews
Remote HEDIS Coordinator
Position Overview
We are hiring a Remote HEDIS Coordinator to conduct abstraction and quality reporting from a secure home environment. This position requires excellent time management, secure data handling, and the ability to collaborate virtually with internal teams and provider offices.
Responsibilities
- Conduct virtual chart abstraction and documentation review
- Communicate with providers via phone and email to retrieve records
- Ensure compliance with HIPAA and NCQA requirements in remote workflows
- Track metrics in shared systems and escalate data discrepancies
- Participate in virtual team meetings and training sessions
Requirements
Hard skills
- Experience using secure, cloud-based HEDIS abstraction tools
- Familiarity with VPNs, encrypted platforms, and remote desktop access
- Strong data integrity and privacy skills
Soft skills
- Self-motivated and highly organized
- Clear written and verbal communication via remote channels
- Accountability in deadline-driven tasks
Education
- Associate’s degree required
Certifications
- HIPAA certification required
- RHIT or HEDIS abstraction certification preferred
Preferred Qualifications
- Prior experience in remote quality assurance or HEDIS roles
- Multistate plan experience
- Comfort working independently with minimal supervision
Medicare HEDIS Coordinator
Position Overview
We are hiring a Medicare HEDIS Coordinator to lead the collection and validation of performance data tied to Medicare Advantage plans. This role ensures compliance with NCQA standards and CMS quality initiatives like STAR ratings. Ideal candidates have a deep understanding of Medicare HEDIS measures and experience managing large-scale data abstraction and chart review.
Responsibilities
- Coordinate HEDIS data collection for Medicare Advantage lines of business
- Monitor adherence to CMS and NCQA timelines and specifications
- Abstract and validate clinical data specific to Medicare measures (e.g., diabetic eye exams, medication adherence)
- Collaborate with STAR ratings and QI teams to improve measure performance
- Conduct chart reviews and ensure documentation accuracy
- Identify data gaps and communicate with providers to retrieve missing information
- Support audit preparation and participate in mock reviews or validation
Requirements
Hard skills
- In-depth knowledge of Medicare-specific HEDIS measures and STAR rating criteria
- Proficiency in EMR systems and claims analysis
- Familiarity with CPT, ICD-10, and HEDIS abstraction software
Soft skills
- Analytical thinking for identifying data trends
- Clear communication with both clinical and non-clinical teams
- Time management in high-volume data review environments
Education
- Associate’s degree required; bachelor’s degree preferred
Certifications
- RHIT or RHIA preferred
- HEDIS abstraction or NCQA compliance training required
- HIPAA certification required
Preferred Qualifications
- Experience working with Medicare Advantage or dual-eligible populations
- Prior involvement with STAR rating improvement initiatives
- Familiarity with CMS reporting platforms and audit processes
Medicaid HEDIS Coordinator
Position Overview
We are seeking a Medicaid HEDIS Coordinator to manage data abstraction and reporting for Medicaid-focused health plans. This role supports HEDIS initiatives tied to state and federal reporting mandates and requires experience with Medicaid populations and their associated performance measures.
Responsibilities
- Abstract and report HEDIS measures aligned with Medicaid contracts and state guidelines
- Support care gap closures through provider and member outreach coordination
- Verify eligibility and demographic accuracy for sampled members
- Work closely with state compliance teams to align submissions with Medicaid benchmarks
- Track performance trends and escalate risk areas for intervention
- Maintain HIPAA-compliant workflows and contribute to audit readiness
Requirements
Hard skills
- Knowledge of Medicaid-specific HEDIS measures and state-level reporting standards
- Experience with managed Medicaid plan operations and data reporting
- Strong EMR and claims abstraction skills
Soft skills
- Precision and persistence in data retrieval
- Cross-functional collaboration with QI, care management, and IT teams
- Cultural sensitivity when working with underserved populations
Education
- Associate’s degree required; bachelor’s preferred
Certifications
- HIPAA certification required
- HEDIS abstraction certification preferred
Preferred Qualifications
- Experience with state Medicaid reporting systems (e.g., EQRO)
- Background in population health or health equity programs
- Spanish or multilingual fluency is a plus