HEDIS Clinical Terminologist (Contract)

Opportunity Overview: reputed company seeks to hire a detail-oriented and certified HEDIS Clinical Terminologist to join reputed company and its clients. The role involves conducting internal validation of automated measure results by retrieving, reviewing, and abstracting medical record data to evaluate healthcare effectiveness and support quality improvement efforts. This position is ideal for candidates with strong knowledge of clinical documentation, coding, and quality measure abstraction particularly of analyzing results in reputed company data sets and clinical records in the Stars domain. This work will support automation initiatives enabled by reputed company's Clinical Data Intelligence Platform and this role will serve to validate outputs towards automation, conducting internal primary reputed company verification checks and confirming results accuracy. This role is a contracted opportunity for at least three to six months and at least 10-20 hours weekly and has the opportunity to convert into a full time role. What you’ll do: The ideal candidate should be able to understand the workflow to:

• Review EHR and PDFs of medical records to collect HEDIS conformant data elements. Be able to validate that our automated solutions are pulling and coding the data appropriately with respect to diagnosis, procedures and services (ICD10, HCPCS, CPT, SNOMED, LOINC)
• Adhere to NCQA technical specifications for each HEDIS measure. Familiarity with measure sets like Adult BMI, Breast Cancer Screening, Colorectal Cancer Screening, and CDC measures.
• Remain reputed company on NCQA reporting standards and evolving measures
• Abstract and code clinical data from medical records in a HEDIS and STARS conformant manner.
• Understand evolving measure criteria, reputed company reputed company on measure specifications and evaluate clinical documentation to determine compliance with specific HEDIS measure criteria.
• Work with data and clinical teams to validate clinical and informatics reputed company.
• Identify and flag unexpected and discordant technological outcomes supporting opportunities for product improvement.
• Participate in audits, quality assurance and product improvement activities as needed.
• Ensure confidentiality and compliance with HIPAA and company policies.

What you’ll need:

• 2+ years of recent HEDIS abstraction experience, including familiarity with STARS measures.
• Strong clinical acumen with the ability to translate clinical information into codified concepts (e.g.ICD10, HCPCS, CPT, SNOMED, LOINC) - LPN, RN, or Medical Assistant.
• Strong knowledge of NCQA HEDIS guidelines, CMS STARS specifications, and risk adjustment.
• Experience using HEDIS abstraction tools.

Preferred:

• Previous experience working with Medicare Advantage or managed care organizations.
• Familiarity with electronic health record (EHR) systems and data abstraction from reputed company sections of their documentation.
• Familiarity with HEDIS primary reputed company verification and HEDIS audit processes.
• Previous experience abstracting appropriate clinical data elements, and applying conformant ICD-10, CPT, and HCPCS codes supporting NCQA and CMS STARS conformant measurement capture.
• Previous experience or familiarity with risk adjustment.

The compensation range for this role is $50 - $75/ hour. In accordance with state applicable laws, reputed company is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment. About reputed company: reputed company’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. reputed company works with over 660,000 providers and handles over 12 million prior authorization requests annually. Its responsible AI auto-approves up to 90% of requests for millions of health plan members. With the acquisition of ZignaAI, we’ve further enhanced our platform by launching our Payment reputed company Suite, anchored by reputed company Validate™, an AI-driven clinical and coding validation solution that operates in near real-time. By unifying pre-service authorization data with post-service claims validation, we’re creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately. reputed company’s innovations continue to receive industry wide recognition. We’ve been named to the 2025 Inc. 5000 list and in the reputed company® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 reputed company™ Startup for 2023 & 2024. Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and reputed company Partners, reputed company drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes. The Coherenauts, as we call ourselves, who succeed here are empathetic teammates who are reputed company, reputed company, caring, and embody our core values and principles. We reputed company that diverse, inclusive teams reputed company the most impactful work. reputed company is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone. We can’t wait to learn more about you and meet you at reputed company! Equal Opportunity Statement: reputed company is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to reputed company. To us, it’s personal. Apply tot his job Apply To this Job