Quality Audit Specialist

W3R Consulting; Illinois; On-site; USD 65,000 - 95,000; Full time

Job summary

W3R Consulting is seeking a detail-oriented HEDIS Data Specialist in Illinois to support data collection and validation of HEDIS clinical datasets. You will audit EMRs and supplemental files to improve accuracy and regulatory compliance, partnering with health plans and providers.

The role requires strong knowledge of HEDIS reporting, NCQA codes, and data analysis, with solid MS Office skills and the ability to navigate new systems independently.

Qualifications

• Strong knowledge of HEDIS reporting and NCQA requirements.
• Experience with healthcare data and auditing in a formal environment.
• Familiarity with CPT II, SNOMED, LOINC, ICD codes and related data sets.

Responsibilities

• Audit and review electronic medical records to ensure data accuracy for HEDIS.
• Oversee data collection from EMRs, non-EMR sources, and supplemental files.
• Communicate complex findings to both technical and non-technical audiences.

Skills

HEDIS reporting

Healthcare data

Data analysis

Audit experience

EMR systems

Coding knowledge

Communication skills

Self-learning

Team collaboration

Tools

MS Office

Excel

Job description

Description: This position supports the data collection of HEDIS clinical data set tied to technical specifications; auditing and review of electronic clinical records to ensure data accurately reflect medical record documentation to meet HEDIS regulatory compliance. Responsible for oversight and review of clinical data from Electronic Medical Records (EMRs) non-EMRs sources; auditing supplemental data files supplied by providers and vendors to improve HEDIS rates/results. This position impacts the integrity of the Medical Record validation process and HealthCare Effective Data & Information Set (HEDIS) Reporting.

Individual must demonstrate strong multi-tasking setting priorities based upon minimal direction including:

• Strong Knowledge of Healthcare Effective Data & Information Set (HEDIS) type of reporting
• Minimum of 3 years Healthcare industry experience; healthcare data
• Strong experience with NCQA and HEDIS reporting, technical data analysis in formal audit formal audit environment.
• Understanding of NCQA HEDIS quality measures and related code value sets.
• Experience in HEDIS value sets and codes applied, including CPT II, SNOMED, LOINC, ICD, HCPCS, and other code sets.
• Strong clinical quality auditing experience
• Strong written and verbal skills; Self-starter problem solving abilities.
• Strong proficiency in MS Office Suite including Word, Excel, PowerPoint, datasets, reporting tools with good multi-tasking skills
• Strong understanding of Electronic Medical Record (EMRs) system from providers, vendors related to HEDIS interpretation
• Conducts analysis and investigation on inquiries related to medical records data collection issues
• Proven to be adept at navigating new systems and technology with little impact to your daily assignments
• Experience with Coding or Certified Coding Certification with HEDIS experience
• Familiar with HIX (Health Insurance Exchange) and EHR (Electronic Health Record) types of data collection.
• Strong interpersonal skill set including ability to support in partner relationship between health plan & provider/vendor community.
• Demonstrate strong initiatives in self-learning with independent trouble shooting, identifying issues and solutioning skills.
• Ability to effectively communicate complex findings to both technical and non-technical audiences.
• Ability to work effectively in a team environment and contribute to shared goal.