HEDIS Quality Audit Lead (Remote)

Health Care Service Corp.; United States; Remote; USD 87,252,000 - 157,540,000; Full time

Job summary

Health Care Service Corporation seeks a licensed RN or LPN to evaluate requirements for HEDIS medical record review, data validation, and quality auditing in a remote setting. You will develop and execute audit strategies, review medical records and HEDIS data, identify discrepancies, and ensure adherence to guidelines while reporting audit status.

The role requires broad knowledge of EMR, healthcare processes, and quality programs, with the ability to work independently and manage multiple

Qualifications

• Bachelor32s degree in technology or business administration with 2 years of testing experience OR 4 years of testing experience.
• Clear and concise verbal, written and interpersonal skills, including the ability to work in teams.
• Analytical and problem-solving skills coupled with initiative and accountability.
• Knowledge of testing methodologies and the Software Development Life Cycle.
• Experience with automated testing tools

Responsibilities

• Evaluate requirements for HEDIS medical record review and data validation.
• Develop and execute audit strategies and review HEDIS data for quality and compliance.
• Identify discrepancies, document findings, and ensure adherence to guidelines.
• Collaborate with stakeholders to research, investigate, and resolve data issues.
• Provide accurate audit status updates and reporting in a remote environment.

Skills

Testing methodologies

SDLC

Analytical thinking

Teamwork

Verbal communication

Education

Bachelor32s degree in technology or business administration

RN or LPN license

Tools

Automated testing tools

Arcadia or similar platform

Excel

Job description

Health Care Service Corporation seeks a licensed RN or LPN to evaluate requirements for HEDIS medical record review, data validation, and quality auditing in a remote setting. You will develop and execute audit strategies, review medical records and HEDIS data, identify discrepancies, and ensure adherence to guidelines while reporting audit status.

The role requires broad knowledge of EMR, healthcare processes, and quality programs, with the ability to work independently and manage multiple