HEDIS Chart Retrieval Nurse
Position Overview
The HEDIS Chart Retrieval Nurse supports the health plan’s annual HEDIS quality data collection efforts by obtaining medical records needed to validate HEDIS measures and close documentation gaps.
In this role, you will conduct outbound outreach to physician offices, hospitals, clinics, and medical records departments to request required documentation. You will coordinate record retrieval, review incoming records for completeness, upload documentation into the health plan’s secure system, and track retrieval progress throughout the project.
This is a fast-paced, deadline-driven role requiring strong communication, organization, attention to detail, and an understanding of clinical documentation and HEDIS quality measures.
Key Responsibilities
- Conduct outbound calls to physician offices, hospitals, clinics, and medical records departments to request records required for HEDIS measures.
- Clearly communicate the purpose of each request, required documentation, applicable date ranges, and release-of-information requirements.
- Coordinate with provider office staff and medical records departments to determine the appropriate method for securely transmitting records.
- Follow up on outstanding requests to ensure medical records are received within established project timelines.
- Review received documentation for completeness and confirm that requested records have been provided.
- Upload medical records into the health plan’s secure portal or designated chart retrieval platform.
- Maintain accurate documentation of outreach attempts, provider contacts, pending requests, completed retrievals, and follow-up activity.
- Escalate delays, access issues, incomplete records, and other retrieval barriers to the project lead or supervisor.
- Manage an assigned call queue and daily outreach workload to meet productivity and retrieval targets.
- Maintain compliance with HIPAA requirements and protect all confidential and protected health information.
- Perform additional project-related duties as assigned.
Qualifications
- Active Registered Nurse (RN) or Licensed Practical Nurse (LPN/LVN) license.
- (compacted license preferred or PA)
- Minimum of 1 year of clinical, managed care, quality, medical records, or related healthcare experience.
- Prior HEDIS, medical record retrieval, chart review, or chart abstraction experience preferred.
- Working knowledge of medical terminology, clinical documentation, and EMR/EHR systems.
- Familiarity with HEDIS quality measures and healthcare quality reporting preferred.
- Strong telephone communication and provider outreach skills.
- Strong attention to detail and ability to accurately document and track multiple record requests.
- Ability to work independently in a remote, deadline-driven environment.
Contract Details
- Monday through Friday schedule
- Eastern Time business hours
- Contract position: This contract does not include health insurance, paid time off, paid holidays, or other employee benefits.
Application Requirements
- Must be legally authorized to work in the United States.
- Candidates must be willing to complete a background check and drug screening if required.
- Candidates will be asked to provide their home address and complete employment eligibility questions during the application process.
Interested in Learning More?
Apply directly or reach out to learn more about the opportunity.