HEDIS Measure Owner (Abstractor)

1 hour, 39 minutes ago
Full-time
Junior
Data Science and Analytics
Clover Health

Clover Health

Clover Health is a data-focused health insurance company that is revolutionizing the Medicare Advantage space by integrating innovative technology into its plans. With a focus on optimizing medical outcomes and reducing costs, Clover Health uses analyt...

Insurance
251-1K
Founded 2014
$925M raised

Description

  • Own assigned HEDIS measures and be accountable for monitoring and improving 5-Star performance.
  • Monitor current rates, trends, gap-to-goal analysis, and hits needed to reach target performance.
  • Review and abstract medical records as they are received.
  • Maintain a productivity pace of 60–80 charts per day while documenting findings accurately to NCQA HEDIS technical specifications.
  • Conduct random audits of incoming data streams to validate completeness and accuracy.
  • Translate chart findings and documentation gaps into actionable insights for providers and care teams.
  • Partner with providers, clinical teams, data teams, and provider engagement teams to close care gaps and improve workflows.
  • Serve as a subject matter expert on assigned HEDIS measures, Medicare Advantage STAR ratings, value sets, and documentation requirements.
  • Validate data sources and identify gaps between claims, supplemental data, and chart findings.
  • Provide guidance to internal teams on measure interpretation, compliance, and reporting accuracy.

Requirements

  • At least 2+ years of HEDIS abstraction experience.
  • Strong knowledge of Medicare Advantage and HEDIS measures and technical specifications.
  • Strong analytical and problem-solving skills.
  • Accountability and ownership mindset.
  • Strong attention to detail with high data and documentation accuracy.
  • Effective communication and collaboration skills.
  • Ability to translate data and chart findings into actionable insights.
  • Ability to work effectively in a remote environment.
  • Associate’s or Bachelor’s degree in a healthcare-related field, or equivalent experience (preferred).
  • Experience with HEDIS abstraction tools (preferred).
  • Experience working with EHR systems and provider workflows (preferred).
  • Exposure to STAR ratings performance strategy (preferred).

Benefits

  • Competitive base salary of $80,000–$100,000 USD.
  • Equity opportunities, including an Employee Stock Purchase Plan (ESPP).
  • Performance-based bonus program.
  • 401(k) matching and regular compensation reviews.
  • Comprehensive medical, dental, and vision coverage.
  • Mental health resources, No-Meeting Fridays, monthly company holidays, and a generous flexible time-off policy.
  • Remote-first work culture with collaboration and flexibility.
  • Learning programs, mentorship, professional development funding, and regular performance feedback.
  • Office setup reimbursement and a monthly cell phone and internet stipend.
  • Paid parental leave for all new parents.

Interested in this position?

Apply directly on the company website

Apply Now

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