Lead Quality Review and Audit Coordinator (RN/LPN) - 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

Job Summary

This position is responsible for evaluating requirements for HEDIS medical record review, data validation, and quality auditing activities prior to production release. Seeking licensed nurses, RN or LPN, with strong clinical knowledge and experience reviewing medical records for quality and compliance. Responsible for developing and executing audit strategies, conducting detailed reviews of medical records and HEDIS data, identifying discrepancies, documenting findings, and ensuring adherence to HEDIS guidelines and quality standards. Works closely with internal stakeholders to research, investigate, and resolve data issues while providing accurate audit status updates and reporting. Focuses on quality, accuracy, and continuous improvement efforts that support Star Rating performance. Requires broad knowledge of healthcare processes, electronic medical records, and quality programs, along with the ability to work independently, manage multiple priorities concurrently, and consistently meet established productivity and accuracy metrics in a remote environment.

Required Job Qualifications

• Bachelor’s 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

Preferred Job Qualifications

• Current, unrestricted RN or LPN license.
• Experience performing HEDIS medical record review, abstraction, auditing, and data validation.
• Strong knowledge of HEDIS measures, quality improvement initiatives, and Star Ratings programs.
• Experience working with electronic medical records (EMR) and reviewing clinical documentation for compliance and quality reporting.
• Experience using Arcadia or similar population health and quality management platforms.
• Advanced proficiency with Microsoft Excel, including data review, analysis, and reporting.
• Demonstrated ability to work independently in a remote, self-directed environment.
• Proven ability to maintain a high level of accuracy in a metric driven environment, including meeting established quality standards.
• Strong attention to detail with experience performing high-volume audit or quality review work.
• Ability to manage competing priorities and meet deadlines during peak HEDIS audit seasons.
• Experience interpreting and applying changing regulatory, quality, or HEDIS guidelines.
• Experience supporting healthcare quality, population health, care management, provider engagement, or quality improvement programs.

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Pay Transparency Statement

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards. The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.

HCSC Employment Statement

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Base Pay Range

$30.45 - $54.98 Exact compensation may vary based on skills, experience, and location.

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About HCSC

For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment.

Accommodation for Applicants with Disabilities

HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations. Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions.

Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.