HEDIS Nurses - Data Managers of Healthcare

Medical records lined up in a file cabinet

You may not be familiar with the term HEDIS nurse, but for the millions of Americans who pick healthcare coverage plans each year the Healthcare Effectiveness and Data Information Set provides a benchmark for comparing plans, based upon the health outcomes of patients covered. So, your provider’s score matters. Each audit season creates many opportunities for healthcare workers. We spoke with two Aerotek HEDIS experts to better understand what sort of worker is drawn to, and excels in, this decidedly mathematical side of healthcare.

So what’s HEDIS?

HEDIS is a widely used set of performance measures in the managed care industry which allows consumers to compare their health plan performance to other plans. The ongoing tracking and scoring of providers is creating regional and national benchmarks for healthier treatment outcomes. According to Aerotek account manager and healthcare practice lead Justin Clark, “It’s a critical measure for patient health outcomes. In the world of healthcare, you have providers — the hospital — and you have payors – the insurance companies. Each year, the insurance companies audit the hospitals where their subscribers receive treatment and score them for successful health outcomes. It’s a rigorous audit, and the results are becoming more and more important to everyone involved — the hospital, insurers and most importantly the patients.

When audit season comes around

Being a HEDIS nurse, an abstractor in industry lingo, is a seasonal job. Justin explained. “We serve one of the largest health insurance providers in the country, and it’s a pretty intense period each year during audit season. The audits start in January and run through May. We start gearing up sourcing contractors in November and are offering positions by December. By January our contractors are heading to the hospitals to begin their work. We call them abstractors, which means they are collecting and inputting treatment data into the insurance company’s HEDIS database. It’s definitely the kind of work really well-suited to people are into details. Perfectionists need apply!”

Profiling the HEDIS nurse

Michon Podgorak is a senior recruiter who works with Justin in Aerotek’s Golden Valley, Minnesota office. We asked her what was special about the top HEDIS nurses she places. “We usually select from registered nurses and licensed practical nurses but medical assistants are in the running as well. Most of our top contractors are registered nurses with strengths in two areas — patient case management and computer skills. Since much of the HEDIS job entails reviewing medical records and making detailed entries into the database, nurses with experience in managing and coding healthcare data make great candidates.”

“The other thing is travel,” Michon continued. “The big insurance companies we work with send our HEDIS nurse contractors out to the hospitals where the data is, so it can sometimes mean hitting the road for five or six months from January to late spring.”

“Many savvy nurses and healthcare professionals are realizing that being a HEDIS nurse is a serious resume booster, and that’s a big selling point for many of our recruits,” Michon said.

How it works, why it matters

According to Justin, both insurers and providers take their annual HEDIS audit equally seriously. “During the early years, most insurers would hire internal staff nurses as their abstractors. But over the past decade, most of them have realized that bringing on specialist contractors for the audit season is a much more efficient approach.”

Justin mentioned that the ongoing scoring has become a visible tracking trend for providers to promote, especially when they’re receiving consistently high HEDIS grades each year.

“Their scores matter, a lot. Everyone is aiming for a perfect five out of five. Coverage costs and plan options can be affected by their scores. It’s the most public record of a hospital’s successful patient health outcomes, so hospitals compete to get and maintain high scores.”

HEDIS as career choice

We asked Michon whether the ideal candidates for becoming a HEDIS nurse were early or late in their healthcare career. “It’s interesting because we find that some nurses newer to their career, especially if they’re technically inclined and open to travel, gravitate to the role. But a good 75% of the top HEDIS nurses we find are actually into the later part of their career. We find they’re more interested in the case management side of nursing and these resource utilization reviews they perform are an interesting change from the direct patient care they practiced for much of their career.”

“It’s pretty rigorous work, and can be repetitious. They have to pass two tests with 95% accuracy or they don’t certify as a HEDIS nurse. We find that whether they’re early or late in their careers, they’re all attracted by the pay and, for the top performers, a chance to go permanent after audit season ends.”

Contractor selfies

We asked Justin and Michon if they could share any stories about HEDIS nurses they’ve placed. “We have a woman who is obsessed with quality and performance and loves the HEDIS work she takes on each year. She’s figured a way to actually do most of her data abstracting at home, and she’s become a star performer. Our client loves her!”

“Another gentleman came with a background in infectious disease medicine and knew nothing about the HEDIS process or systems. Again, the client where we placed him loved him and he went permanent after one audit season.”

Justin talked about a candidate who was looking for a foot in the door of a particular company. “We found a contractor here in Minnesota that really wanted to work for this large national insurer, one of our largest clients. He saw the opportunity to get into the company by working as a HEDIS nurse contractor. That was years ago, and he’s been permanent there ever since.”

If you’re a healthcare professional thinking about becoming a HEDIS nurse, check our opportunities for the upcoming 2018 audit season as we get closer to November, or update your free Aerotek career account today.