Play a key role in strengthening healthcare quality across Massachusetts and New Hampshire. This remote role helps drive accurate HEDIS reporting, regulatory compliance, and measurable quality outcomes for members.
About WellSense Health Plan
WellSense is a nonprofit health insurance company serving more than 740,000 members across MA and NH through Medicare, Medicaid, and Individual/Family plans. Founded in 1997, we’re committed to delivering high-quality, equitable healthcare and supporting members no matter their circumstances.
Schedule
- Full-time, fully remote
- Standard business hours with flexibility based on provider outreach and reporting timelines
- Must maintain reliable attendance and meet accuracy and productivity standards
What You’ll Do
⦁ Perform medical record abstraction and data entry for NCQA HEDIS and other audit-based measures
⦁ Maintain ≥90% inter-rater reliability accuracy and complete yearly testing
⦁ Conduct overreads to validate accuracy, consistency, and compliance with technical specifications
⦁ Navigate multiple EMR systems (Epic, Cerner, Allscripts) to retrieve and abstract medical records
⦁ Build and maintain strong relationships with provider partners to ensure timely record retrieval
⦁ Research member and claims data using internal systems to validate service information
⦁ Support chart procurement efforts and maintain a retrieval rate of ≥95%
⦁ Assist with training on HEDIS measures, abstraction methods, and data collection practices
⦁ Identify workflow improvement opportunities and contribute to quality initiatives
⦁ Participate in cross-functional project teams focused on performance and quality improvement
⦁ Promote a data-driven culture of continuous improvement
⦁ Perform other related duties as assigned
What You Need
⦁ Bachelor’s degree in Healthcare Administration, Nursing, Public Health, or related field (or equivalent experience)
⦁ Minimum 2 years of experience in healthcare quality, medical record abstraction, or managed care
⦁ Working knowledge of HEDIS measures and abstraction methodology
⦁ Strong attention to detail and problem-solving skills
⦁ Proficiency with Microsoft Office and ability to learn multiple software systems
⦁ Strong verbal and written communication skills
⦁ Ability to work collaboratively and independently
Preferred
⦁ Experience with quality reporting, audits, or supplemental data submissions
⦁ Coding/clinical background or health information certification
Benefits
⦁ Competitive salary: $61,500–$89,500 (adjusted for location)
⦁ Medical, dental, vision, and pharmacy benefits
⦁ 403(b) with employer match
⦁ Paid time off and wellness resources
⦁ Career growth opportunities
Ready to help improve healthcare quality across the region? Apply today — positions fill fast.
Happy Hunting,
~Two Chicks…