HEDIS Abstractor (LA Region)

HEDIS Abstractor
Department:

Quality - Quality Care Improvement

Employment Type:

Full Time

Location:

1600 Corporate Center Dr., Monterey Park, CA 91754

Reporting To:

Marie Halbrook

Compensation:

$27.00 - $33.00 / hour

Description
The HEDIS Abstractor supports Quality Care Improvement initiatives by conducting comprehensive medical record reviews and abstraction activities to identify and close HEDIS measure care gaps. This role is responsible for ensuring accurate collection, validation, and submission of clinical data in accordance with NCQA HEDIS technical specifications and regulatory guidelines. The HEDIS Abstractor collaborates with internal quality teams, providers, and external audit vendors to improve measure performance, maintain compliance, and support successful HEDIS audits.

What You'll Do

Perform medical record abstraction and chart review for HEDIS and quality improvement initiatives

Identify and close HEDIS care gaps through accurate review and documentation of clinical records

Interpret and apply HEDIS measure specifications, coding guidelines, and NCQA technical requirements

Review and validate data for accuracy, completeness, and compliance with HEDIS standards

Conduct quality assurance (QA) reviews of abstracted records and audit findings

Collaborate with providers, clinics, health plans, and internal departments to obtain required medical documentation

Partner with external audit vendors to support medical record retrieval, validation and audit readiness activities

Analyze abstraction results and identify trends, discrepancies, or opportunities for process improvement

Ensure compliance with HIPAA and all applicable privacy and confidentiality regulations

Maintain productivity and accuracy standards while meeting project deadlines

Support continuous quality improvement initiatives and assist with reporting activities as needed

Other duties as assigned

Qualifications

High school diploma or equivalent required; associate or bachelor's degree in a healthcare-related field

Minimum of 2 years of HEDIS abstraction or medical record review experience

Strong knowledge of NCQA HEDIS measure specifications and quality improvement processes

Proficiency with ICD-10, CPT, HCPCS, and other clinical coding systems

Experience performing QA reviews and supporting HEDIS audit activities

Familiarity with EMR/EHR systems and healthcare documentation workflows

Strong analytical, organizational, and problem-solving skills

Excellent attention to detail and accuracy

Ability to work independently and manage multiple priorities in a fast‑paced environment

Strong written and verbal communication skills

You're great for the role if:

Certified Professional Coder (CPC), RHIT, RHIA, LVN/LPN, RN, or other healthcare-related certification

Experience working with health plans, managed care organizations, or quality improvement departments

Knowledge of CMS Stars, risk adjustment, and population health initiatives strongly preferred

Environmental Job Requirements and Working Conditions

Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr, Monterey Park CA 91754.

This role will require travelling locally up to 35% of the time.

The annual total compensation target pay range for this role is: $27.00 - $32.00 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and affirmative action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.

Additional Information
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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