The Role
Perform chart reviews and medical record abstraction to identify and close HEDIS care gaps. Apply NCQA HEDIS specifications and coding guidelines, validate and QA clinical data, support audits, collaborate with providers and vendors, analyze results for process improvement, and maintain HIPAA-compliant documentation while meeting productivity and accuracy targets.
Summary Generated by Built In
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 [email protected] 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.
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
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient. Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Skills Required
- High school diploma or equivalent
- Associate or bachelor’s degree in a healthcare-related field
- Minimum of 2 years 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
- Strong written and verbal communication skills
- 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
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The Company
What We Do
Astrana Health is a physician-centric, technology-powered healthcare company that operates an integrated delivery platform. It enables providers to participate in value-based care arrangements, helping them deliver accessible, high-quality, and cost-effective care to patients. The company provides care coordination services to patients, primary care physicians, specialists, and health plans, leveraging proprietary technology to streamline operations and improve patient outcomes across local communities.
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