Job Description

Position Title: Quality Improvement Abstractor

Location: Remote

Duration: 4 months

Schedule: 7 am to 4 pm, or 8 to 5 pm CST

Position Summary

The Quality Improvement Abstractor is responsible for leading data collection and medical record abstraction for quality measures, including HEDIS, CMS, CHIPRA, and other custom measurement sets. This role supports the Clinical Quality Team during the MY2025 HEDIS Project in 2026 and plays a critical role in ensuring data accuracy, compliance with standards, and quality outcomes.

Key Responsibilities

• Review and abstract medical records in compliance with HEDIS and other quality measure standards
• Perform independent abstraction and over-read activities
• Assess vendor-delegated abstraction results against HEDIS and custom measure standards
• Track, document, and report abstraction issues, discrepancies, and outcomes
• Communicate abstraction findings with health plans and vendors as required
• Participate in team meetings and quality initiatives
• Apply critical thinking to interpret clinical documentation and quality standards
• Utilize multiple software platforms for data entry, tracking, and reporting

Performance Expectations

• Complete required HEDIS training and testing (up to 3 attempts)
• Minimum passing score: 95%
• Review an average of 40+ medical records per day
• Maintain 95% accuracy on medical record abstraction and over-reads

Required Qualifications

Education & Licensure

• Required: Active Texas RN or LVN license
• Preferred: Bachelor of Science in Nursing (BSN)

Experience

• Prior experience with HEDIS abstraction and over-reading
• Experience in nursing, medical assisting, medical coding, or quality data management
• Familiarity with NCQA standards and quality initiatives preferred
• Technical Skills (Top Must-Have Skills)
• Proficiency in Microsoft Applications (Excel, Outlook, Teams, SharePoint)
• Ability to consistently meet productivity and accuracy metrics
• Hands-on experience with HEDIS abstraction and over-read processes
• Additional Skills & Attributes
• Strong critical thinking and attention to detail
• Ability to work independently in a remote environment
• High level of computer literacy and adaptability to multiple systems
• Experience using platforms such as Excel, QMRM, SharePoint, and MS Teams

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