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HEDIS Abstractor

Astrana Health, Inc.

Monterey Park, California

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JOB DETAILS
SALARY
$27–$33 Per Hour
SKILLS
Analysis Skills, Certified Professional Coder (CPC), Clinical Data, Clinical Information Systems, Clinical Study Publications, Communication Skills, Compensation Management, Content Management Systems (CMS), Current Procedural Terminology (CPT), Data Quality, Detail Oriented, Documentation, Electronic Medical Records, Environmental Work, External Audit, HIPAA (Health Insurance Portability and Accountability Act), Health Plan, Healthcare, Healthcare Common Procedure Coding System (HCPCS), Healthcare Effectiveness Data and Information Set (HEDIS), High School Diploma, ICD-10, Licensed Practical Nurse/Licensed Vocational Nurse, Maintain Compliance, Managed Care, Medical Coding, Medical Office Administration, Medical Record System, Medical Records, Multitasking, National Committee for Quality Assurance (NCQA), Performance Management, Performance Metrics, Presentation/Verbal Skills, Process Improvement, Quality Assurance, Quality Management, Quality Metrics, Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Regulations, Regulatory Compliance, Regulatory Requirements, Risk, Time Management, Trend Analysis, Vendor/Supplier Evaluation, Willing to Travel, Writing Skills
LOCATION
Monterey Park, California
POSTED
6 days ago

Description


The HEDIS Abstractor supports Quality Care Improvement initiatives by conducting comprehensive medical record reviews and abstraction activities to identify and close HEDIS measure care gaps. This role is responsible for ensuring accurate collection, validation, and submission of clinical data in accordance with NCQA HEDIS technical specifications and regulatory guidelines. The HEDIS Abstractor collaborates with internal quality teams, providers, and external audit vendors to improve measure performance, maintain compliance, and support successful HEDIS audits.

What You'll Do


  • Perform medical record abstraction and chart review for HEDIS and quality improvement initiatives
  • Identify and close HEDIS care gaps through accurate review and documentation of clinical records
  • Interpret and apply HEDIS measure specifications, coding guidelines, and NCQA technical requirement
  • Review and validate data for accuracy, completeness, and compliance with HEDIS standards
  • Conduct quality assurance (QA) reviews of abstracted records and audit findings
  • Collaborate with providers, clinics, health plans, and internal departments to obtain required medical documentation
  • Partner with external audit vendors to support medical record retrieval, validation and audit readiness activities
  • Analyze abstraction results and identify trends, discrepancies, or opportunities for process improvement
  • Ensure compliance with HIPAA and all applicable privacy and confidentiality regulations
  • Maintain productivity and accuracy standards while meeting project deadlines
  • Support continuous quality improvement initiatives and assist with reporting activities as needed
  • Other duties as assigned

Qualifications


  • High school diploma or equivalent required; associate or bachelor’s degree in healthcare-related field
  • Have at least 2 year of HEDIS abstraction or medical record review experience
  • Strong knowledge of NCQA HEDIS measure specifications and quality improvement processes
  • Proficiency with ICD-10, CPT, HCPCS, and other clinical coding systems
  • Experience performing QA reviews and supporting HEDIS audit activities
  • Familiarity with EMR/EHR systems and healthcare documentation workflows
  • Strong analytical, organizational, and problem-solving skills
  • Excellent attention to detail and accuracy
  • Ability to work independently and manage multiple priorities in a fast-paced environment
  • Strong written and verbal communication skills
You're great for the role if:
  • Certified Professional Coder (CPC), RHIT, RHIA, LVN/LPN, RN, or other healthcare-related certification 
  • Experience working with health plans, managed care organizations, or quality improvement departments
  • Knowledge of CMS Stars, risk adjustment, and population health initiatives strongly preferred

Environmental Job Requirements and Working Conditions


  • Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr, Monterey Park CA 91754. 
  • This role will require travelling locally up to 35% of the time.
  • The annual total compensation target pay range for this role is: $27.00 - $33.00 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at

humanresourcesdept@astranahealth.com

to request an accommodation.

Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

About the Company

A

Astrana Health, Inc.

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