AmeriHealth Caritas HEDIS Data Reviewer in Philadelphia, Pennsylvania

HEDIS Data Reviewer

Location: Philadelphia, PA

Telecommuter?: Yes

ID**: 14272

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us


Under the direction of the HEDIS Manager the HEDIS Data Reviewer or Over reader is responsible for performing medical records abstraction in support of the annual Healthcare Effectiveness Data and Information Set (HEDIS) with duties including but not limited to the following:

  • Responsible for the coordination of the medical records identification process, collection activities and review for

  • Performs and applies structured auditing abstraction criteria to medical records to determine compliance

  • Utilizes various software applications to support HEDIS operations and accurately enters the results of chart audits into the database.

  • Complete the HEDIS Medical Record Review abstraction tool and provide feedback to providers for medical records that do not meet the HEDIS Technical Specifications criteria within a live software environment

  • Provide clinical and administrative support to providers.

  • Maintain productivity level of a minimum of chases/charts per hour according to policy

  • Maintain an abstraction proficiency rate of 98% by correctly reading, interpreting, and abstracting various components of the medical record such as notes, consultations, medication forms, treatment plans, health history, interval history, and past history.

  • Work on designated projects assigned and deemed as necessary.

  • Assists in the Medical Record collection process including making phone calls, sending out faxes/letters or chart retrieval to providers if assigned by manager.

  • On an annual basis develops expertise in the requirements and parameters of mandated HEDIS performance measures.


  • Bachelor’s degree required

  • 3-5 years working with HEDIS data including chart review/collection. Demonstrated expertise in managing a HEDIS project is very valuable.

  • Knowledge of medical terminology and basic charting to include diabetic labs, HPV testing, preventive health screenings, immunization and well care terminology.

  • HEDIS, QRS, or STARs experience.

  • Understanding of current HEDIS Technical Specifications.

  • Knowledgeable in the MRRV process.

  • Proficiency in Excel, Word, Power Point and Outlook.

  • Experience and williness to learn any Medical Record Abstraction Tool.

  • Past experience in the Pediatric, Maternity, Diabetic or Provider Office Setting.

  • Familiar with the Cancer Registry Abstractor.

  • Familiar with Bright Futures.

  • Strong written and oral communication skills, critical thinking skills, strong organizational skills.

  • Able to think and work effectively under pressure.

EOE Minorities/Females/Protected Veterans/Disabled