Hybrid HEDIS Data Quality Specialist

HealthFirst; Herminie (PA); Hybrid; USD 61,000 - 100,000; Full time

Job summary

The Clinical Quality Specialist at HealthFirst is responsible for HEDIS medical record review, data abstraction, and validation to support NCQA, CMS, and regulatory reporting.

You will collaborate with providers, vendors, and internal teams to ensure data integrity, audit readiness, and continuous quality improvement. This hybrid role includes on-site work at the New York, NY office and remote work options.

Qualifications

• Bachelor’s degree from an accredited college or university in Nursing, Public Health, Health Administration, Healthcare Management, Public Policy, or a related field required.
• 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 and provider records.
• Ensures accuracy, completeness, and integrity of HEDIS data for regulatory reporting and QA initiatives.
• Identifies and resolves data discrepancies and supports audit readiness.
• Collaborates with Quality Improvement, Analytics, Coding, and operational teams.

Skills

HEDIS knowledge

Data abstraction

Healthcare analytics

EMR data review

Audit readiness

Microsoft Office

Communication skills

Education

Bachelor’s degree in Nursing/Public Health/related field

Tools

EMR systems

Data abstraction tools

Microsoft Excel

Job description

The Clinical Quality Specialist at HealthFirst is responsible for HEDIS medical record review, data abstraction, and validation to support NCQA, CMS, and regulatory reporting.

You will collaborate with providers, vendors, and internal teams to ensure data integrity, audit readiness, and continuous quality improvement. This hybrid role includes on-site work at the New York, NY office and remote work options.