HEDIS Review Jobs: Skills, Requirements, And Tips For Success | Jane Jackson, RN, CRC | RxEconsult

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Skills And Requirements For HEDIS Review Jobs Category: Nursing by - October 13, 2016 | Views: 40237 | Likes: 1 | Comment: 0  

HEDIS Review Jobs

Upcoming HEDIS Season – Review Jobs are Posted

HEDIS (Health Effectiveness Data Information Set) is coming. Whether you are seeking a 20 hour a week moonlighting position or a temporary full-time job for 40 hours a week - companies involved in HEDIS have HEDIS review jobs and they are hiring now. HEDIS is used by 90% of Medicare, Medicaid, and even private insurance companies to establish Star Rating with the Center for Medicare and Medicaid Services. 

There are 88 HEDIS measures to be reviewed for HEDIS 2017. Each measure has specific compliance criteria in order to get a “hit”. Example:  Diabetic Retinal Exams – screening for Diabetic Retinopathy. There are two ways to meet criteria for this measure – a dilated eye exam in 2015 with documentation of No Retinopathy or any dilated eye exam in 2016. Either of these would be considered a “hit”.

Most managed care companies use a HEDIS vendor service for this huge annual project. HEDIS vendors are highly specialized companies that maintain a staffing pool of experienced HEDIS reviewers.

HEDIS data is generally collected by two methods – onsite or remote.

An onsite reviewer travels to a provider office to reviews charts. Information is either printed or digitally downloaded. Using the example of the eye exam above, an on-site reviewer would search the patient’s medical record and download or print a copy of the eye exam. This information is then reported back to the vendor company to eventually be reported back to the managed care organization.

A remote reviewer uses a secure internet portal to access records. Records are either collected by a scan service vendor or sent in by the provider office. Remote reviewers access the reports online, search for proof a measure was met, then report this information back to the vendor who will relay the information to the managed care company.

In a five-minute online search this morning, using HEDIS as the job description, this is what I found:

  • Indeed – 1738 openings
  • CareerBuilder – 254 opening
  • Monster – 1000+ opportunities
  • Glassdoor – 192 openings
  • SimplyHired – 1574 opportunities
  • Jobs.com – 2550 openings
  • LinkedIn – 1536 opportunities



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