Help drive real quality outcomes behind the scenes for Medicaid and Medicare members by owning HEDIS data accuracy, chart abstraction, and quality reporting in a fully remote role.
About WellSense Health Plan
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded as Boston Medical Center HealthNet Plan, WellSense focuses on delivering high quality coverage that works in real life, no matter a member’s circumstances. The plan is committed to health equity, diversity, and data driven improvement.
Schedule
- Position type: Full time
- Work setting: 100 percent remote within the United States
- Hours: Standard weekday business hours, with some flexibility based on project timelines and reporting cycles
- Collaboration: Regular virtual interaction with Quality, Analytics, Clinical, and Provider teams
Responsibilities
- Perform medical record abstraction and data entry for NCQA HEDIS and other medical record based regulatory audits.
- Maintain an inter rater reliability (IRR) score of at least 90 percent on required annual testing.
- Conduct overreads of abstracted charts to confirm accuracy, consistency, and adherence to technical specifications.
- Access, navigate, and abstract medical records from multiple EMR platforms such as EPIC, Allscripts, and Cerner.
- Build and maintain strong relationships with provider practices to support timely, accurate medical record retrieval and HEDIS timelines.
- Use internal systems to research member and claims data, validate service information, and confirm correct provider locations.
- Collaborate with internal teams and provider offices to achieve a chart procurement rate of at least 95 percent.
- Support training and education on HEDIS measures, diagnosis capture, data collection, and quality improvement concepts.
- Identify opportunities to improve abstraction workflows and quality performance.
- Participate in cross functional workgroups focused on measure performance and quality improvement initiatives.
- Promote a culture of continuous improvement and data driven decision making.
- Complete other related duties as assigned.
Requirements
Education
- Bachelor’s degree in Healthcare Administration, Nursing, Public Health, or a related field, or an equivalent combination of education and experience.
Experience
- At least 2 years of experience in healthcare quality, medical record abstraction, or managed care.
- Hands on knowledge of HEDIS measures and abstraction methodologies.
Preferred
- Experience supporting quality reporting, audits, or supplemental data submissions.
- Clinical background or certification in medical coding or health information.
Skills and Attributes
- Strong attention to detail with a track record of meeting accuracy standards.
- Comfortable working in multiple systems with proficiency in Microsoft Office.
- Able to explain technical or regulatory requirements clearly in both written and verbal communication.
- Collaborative mindset with the ability to build relationships with internal teams and external providers.
- Reliable, organized, and able to manage time in a fully remote environment.
Benefits
- Estimated salary range: 61,500 to 89,000 dollars annually, depending on experience, education, skills, and location.
- Medical, dental, vision, and pharmacy coverage.
- Generous paid time off and paid holidays.
- Merit increase opportunities.
- Flexible Spending Accounts.
- 403(b) savings with employer match.
- Career development and advancement opportunities within a growing regional health plan.
- Resources and programs that support employee and family wellbeing.
If you enjoy turning messy data into clean, reliable quality measures and want remote stability with meaningful impact, this role is worth a serious look.
Happy Hunting,
~Two Chicks…