Note: The job is a remote job and is open to candidates in USA. SPECTRAFORCE is seeking a Quality Improvement Abstractor to support its HEDIS contractor team and quality measurement activities. The role leads medical record retrieval, documentation, abstraction, quality review, reporting, and communication with providers, health plans, and vendors.
Responsibilities
- Assist with retrieval of medical records
- Works with the HEDIS Ops and Risk Adjustment teams to collect member records by contacting providers and placing collected records into database utilized
- Required to handle a high-volume (40-50 per day) of inbound and outbound calls with provider offices
- Continued follow up on requested medical records until obtained
- Excellent documentation of research and contact information
- Labeling records with appropriate naming convention
- Loading medical records to abstraction database
- Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards
- Review medical records and abstract data for HEDIS and other measure sets in compliance with standards
- Track and report on issues and outcomes related to abstractions and over-reads
- Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required
- Perform other quality initiatives as necessary
- Performs other duties as assigned
- Complies with all policies and standards
Skills
- Work Location : Remote NC – Candidates must reside in NC
- Work Schedule : Training 2-week course M-F 8am-5pm EST; Working schedule M-F 8am-5pm EST; No OT
- Required: Associate Degree RN – NC or Compact state license
- Required: LPN - NC
- • Minimum 4 years of nursing experience (active RN required)
- • At least 1 year of experience in medical record review, quality improvement, or related administrative clinical work, call center
- • No active RN/LPN license or lapsed/expired license
- • Lack of experience with medical record systems or electronic documentation
- • Inability to commit to full-time schedule during the contract period
- • Limited computer proficiency (unable to navigate Excel or complete required computer testing)
- • Refusal or inability to be on camera for required training and testing
- • Strong organizational skills and attention to detail
- • Ability to handle a high-volume workload under tight timelines
- • Professional communication and follow-up skills with provider offices
- • Reliability and accountability in meeting daily call/fax and documentation expectations
- Medical record retrieval and documentation accuracy (critical for data integrity)
- Strong computer skills (Excel, medical record software, and ability to pass computer testing)
- Effective provider communication (handling high call/fax volume with professionalism)
- Preferred: Bachelor degree preferred
- Preferred: RN – NC or Compact state license
Benefits
- Remote work arrangement
Company Overview
Company H1B Sponsorship