HEDIS Abstractor/Overreader

Pride Health; United States; Remote; USD 48,000 - 58,000; Full time

Benefits offered by this job

Healthcare coverage

401(k)-retirement savings

Life & disability insurance

Employee assistance program

Legal support

Pet insurance

Employee discounts

Job summary

PrideGlobal is seeking a HEDIS-Clinical Quality Analyst to support QA activities related to HEDIS quality measures for 2027. This contract role is remote in the United States, with a Monday–Friday schedule from 8:00 AM to 5:00 PM EST and a January 2027 to April 2027 commitment.

The position pays $35 to $42 per hour, with pay based on experience, credentialing, and education. Responsibilities include chart reviews, provider outreach, and quality improvement activities within a HIPAA-compliant

Qualifications

• 1+ year of HEDIS and/or medical record review experience preferred.
• Healthcare, health plan, or managed care industry experience preferred.
• Intermediate or higher proficiency with Microsoft Office applications (Word, Excel, Adobe, PowerPoint).

Responsibilities

• Perform quality assurance reviews and overreads of HEDIS chart review and data collection.
• Provide remediation training and coaching based on quality findings.
• Maintain HIPAA compliance and confidentiality of PHI.
• Report critical incidents and communicate questions to leadership.
• Participate in team meetings and provide updates on clinical reviews and analyst performance.
• Complete HEDIS technical specification training/testing with 95%+ passing score.
• Conduct provider outreach and medical record requests to obtain compliant data.
• Perform other QA, chart review, and quality improvement duties.

Skills

HEDIS knowledge

Quality assurance

HIPAA compliance

Data integrity

Documentation

Education

RN/LPN/LVN licensure preferred

Tools

Microsoft Word

Microsoft Excel

Adobe

PowerPoint

Job description

Our client, one of the largest healthcare corporations, is seeking a large number HEDIS-Clinical Quality Analyst to support quality assurance activities related to HEDIS® quality measures for 2027.

Contract Job: W-2 - Remote in US ONLY!

Schedule: Monday–Friday, 8:00 AM–5:00 PM EST

Assignment Commitment: January 2027 to April 2027, with minimal to no absences

Pay Rate: $35 to $42 per hour *Pay offered is based on experience, expertise, credentialing, and education.

Key Responsibilities:

• Perform quality assurance reviews and overreads of Clinical Quality Analysts' HEDIS® chart review and data collection.
• Provide remediation training and coaching based on quality findings.
• Maintain HIPAA compliance and confidentiality of protected health information (PHI).
• Report critical incidents and communicate questions or concerns to appropriate leadership.
• Participate in team meetings and provide updates on clinical reviews and analyst performance.
• Successfully complete HEDIS® technical specification training/testing with a 95% or higher passing score and required software training.
• Conduct provider outreach and medical record requests to obtain compliant data.
• Perform other quality assurance, chart review, and quality improvement duties as assigned.

Qualifications and Experience:

• Strong proficiency with Microsoft Office applications, including Word, Excel, Adobe, and PowerPoint.
• Ability to successfully complete required HEDIS® technical specification training and testing with a passing score of 95% or higher.
• Ability to commit to the full January to April 2027 assignment with minimal to no absences.
• 1+ year of HEDIS® and/or medical record review experience preferred.
• 1+ year of healthcare, health plan, or managed care industry experience preferred.
• Experience with clinical data abstraction and overread preferred.
• HEDIS® experience with one or more of the following quality measures preferred: BPD, CBP, COA, HBD, and TRC.
• Experience performing overreads of HEDIS® quality measures preferred.
• Management or supervisory experience, particularly experience leading or overseeing a team, preferred.
• Clinical licensure such as RN, LPN, or LVN preferred but not required.
• Intermediate or higher proficiency with Microsoft Office applications, including Word, Excel, Adobe, and PowerPoint.

For workers in the United States, PrideGlobal and it's affiliates offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, pet insurance and employee discounts with preferred vendors.

PrideGlobal and it's affiliates are an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

PrideGlobal and it's affiliates are a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.

Accommodations

We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

Only applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.

Only applicable for Kentucky positions: For this type of employment, state law requires a criminal record check as a condition of employment. This applies to direct care staff (Examples: RN, LPN, Nurse Aides, Therapists) referred to Kentucky nursing facilities, assisted living communities, or long-term care facilities, in accordance with KRS 216.793.