Support a mission-driven health plan by ensuring accurate HEDIS reporting, high-quality medical record abstraction, and regulatory compliance that directly impact member care and organizational performance.
About WellSense Health Plan
WellSense is a nonprofit health insurance plan serving more than 740,000 members across Massachusetts and New Hampshire. With over 25 years of experience, we provide Medicare, Medicaid, and Individual/Family plans built around accessibility, quality, and real-life support. Our team is dedicated to improving health outcomes and creating a better experience for every member.
Schedule
• Full-time
• Fully remote
• Standard business hours; some seasonal workload increases during HEDIS reporting cycles
Responsibilities
• Perform medical record abstraction and data entry for NCQA HEDIS® and related medical record–based audits
• Maintain an inter-rater reliability score of 90 percent or higher
• Conduct overreads to ensure accuracy and adherence to technical specifications
• Access, navigate, and abstract medical records across multiple EMR platforms (Epic, Cerner, Allscripts, etc.)
• Build collaborative relationships with provider partners to ensure timely, accurate record retrieval
• Use health plan systems to research member and claims data and validate service details
• Work with internal teams and provider offices to support a chart procurement rate of at least 95 percent
• Assist in annual training sessions on HEDIS measures, documentation practices, and data collection standards
• Identify and recommend improvements in abstraction workflows and quality performance
• Participate in cross-functional projects that support quality improvement and measure performance
• Promote a culture of continuous improvement and data-driven decision-making
• Perform additional quality-related duties as needed
Requirements
• Bachelor’s degree in healthcare administration, nursing, public health, or related field; or equivalent experience
• Minimum two years of experience in healthcare quality, medical record abstraction, or managed care
• Knowledge of HEDIS® measures and abstraction methodology
• Strong attention to detail with proven accuracy in data validation
• Proficiency in Microsoft Office and ability to learn multiple proprietary systems
• Effective written and verbal communication skills
• Ability to work collaboratively across departments and with external provider partners
Preferred
• Experience with quality reporting, regulatory audits, or supplemental data submissions
• Medical coding or clinical background
Benefits
• Competitive salary
• Medical, dental, vision, and pharmacy coverage
• 403(b) with employer match
• Flexible Spending Accounts
• Paid time off and wellness resources
• Career growth and advancement opportunities
• Full-time remote work
If you’re detail-oriented, thrive in a quality-driven environment, and want to help improve healthcare outcomes across multiple populations, this role fits you well.
Happy Hunting,
~Two Chicks…