HEDIS Data Quality Specialist (Hybrid)

Healthfirst; Layton (UT); Hybrid; USD 61,000 - 91,000; Full time

Job summary

Healthfirst seeks a Clinical Quality Specialist to lead HEDIS medical record review, abstraction, and validation across internal and external data sources. The role supports regulatory reporting, quality improvement, and audit readiness in a hybrid work environment with an office in New York.

The candidate will collaborate with providers, vendors, and internal teams to ensure NCQA, CMS, and state standards are met, while maintaining data integrity and documenting processes.

Qualifications

• Bachelor’s degree in Nursing, Public Health, Health Administration, Healthcare Management, Public Policy, or related field.
• Experience: minimum 1 year in healthcare quality, HEDIS operations, medical record review, data abstraction, or healthcare analytics.
• Knowledge of MS Office Applications.

Responsibilities

• Performs HEDIS medical record review, abstraction, data entry and validation activities.
• Reviews and validates clinical documentation and coding from EMRs, provider records, vendors, and other sources.
• Ensures accuracy, completeness, and integrity of HEDIS data for regulatory reporting and quality initiatives.
• Ensures compliance with NCQA supplemental data standards.
• Identifies and resolves data discrepancies and gaps; supports audits and audit readiness.

Skills

HEDIS knowledge

Data abstraction

Regulatory compliance

Analytical skills

Microsoft Office

Communication skills

EMR systems

Education

Bachelor’s degree in Nursing or related field

Tools

EMR systems

Data abstraction tools

Job description

Healthfirst seeks a Clinical Quality Specialist to lead HEDIS medical record review, abstraction, and validation across internal and external data sources. The role supports regulatory reporting, quality improvement, and audit readiness in a hybrid work environment with an office in New York.

The candidate will collaborate with providers, vendors, and internal teams to ensure NCQA, CMS, and state standards are met, while maintaining data integrity and documenting processes.