Quality Audit Specialist

VIVA; United States; Remote; USD 70,000 - 110,000; Full time

Job summary

VIVA USA Inc. is seeking a contract HEDIS Data Analyst to support data collection and auditing of clinical records to ensure HEDIS regulatory compliance.

The role involves reviewing EMR and non-EMR data, auditing supplemental provider files, and ensuring accurate reflection of documentation. Ideal candidates have 3+ years of healthcare data experience, strong NCQA/HEDIS knowledge, and proficiency with MS Office and coding/value sets.

Qualifications

• HEDIS reporting experience and NCQA familiarity required.
• Experience auditing healthcare data and EMR-based records.
• Strong written and verbal communication; self-starter with problem solving.
• Familiarity with coding/value sets (CPT II, SNOMED, LOINC, ICD, HCPCS).

Responsibilities

• Audit and review of electronic clinical records to ensure HEDIS data accuracy.
• Oversee data from EMRs and non-EMR sources; audit supplemental files from providers.
• Analyze inquiries related to medical records data collection issues.
• Communicate complex findings to technical and non-technical audiences.

Skills

HEDIS reporting

NCQA knowledge

EMR data analysis

Code sets (CPT II, SNOMED, LOINC, ICD,

MS Office (Word, Excel, PowerPoint)

Communication of complex findings

Team collaboration

Tools

EMR systems

Job description

Fully remote in any state except NY, CA, HI or AK

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 year’s 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.

Notes:

Fully remote in any state except NY, CA, HI or AK

This is a contract role with the possibility of conversion to full-time based on business needs and performance

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status