Position Summary

Eclat Health Solutions is seeking experienced HEDIS Reviewers to support a large-scale validation initiative for our AI-powered clinical abstraction platform. In this role, you will review and validate HEDIS-related CPT, HCPCS, LOINC, and RxNorm abstractions generated by a Large Language Model (LLM), ensuring the accuracy, completeness, and clinical integrity of the data.

This position requires strong analytical skills, knowledge of HEDIS measures, and experience reviewing outpatient medical records to validate qualifying clinical events and supporting documentation.

Key Responsibilities

Review medical records to validate AI-generated HEDIS abstractions.

Verify supporting documentation for CPT, HCPCS, LOINC, and RxNorm codes.

Identify false positives, false negatives, and abstraction discrepancies.

Validate qualifying clinical evidence in accordance with NCQA and client guidelines.

Document findings using standardized review templates.

Escalate complex or ambiguous cases to Quality Leadership.





Participate in training and calibration sessions to ensure reviewer consistency.

Meet established productivity, quality, and turnaround time expectations.

Minimum Qualifications

Candidates must meet one of the following qualifications:

*Clinical Background*
- Registered Nurse (RN), Physician (MD/DO), MBBS graduate, or other licensed clinical skilled
- Minimum of 2 years of HEDIS abstraction, quality measure review, or medical record review experience

OR

*Coding Background*
- Minimum of 3 years of Professional Fee (Profee) outpatient coding or CPT/HCPCS abstraction experience
- CPC certification preferred (AAPC) or equivalent coding credential
- Experience reviewing outpatient physician documentation

Preferred Qualifications
- HEDIS abstraction experience
- Professional Fee (Profee) coding experience
- CPT and HCPCS abstraction experience
- Quality assurance or coding audit experience
- Knowledge of NCQA HEDIS specifications
- Knowledge of

📌 HEDIS Reviewer with (Hyderabad)
🏢 Eclat Health Solutions
📍 Hyderabad