Quality Improvement Specialist (Non-Clinical)

Randstad USA; Arizona; Remote; USD 27,000 - 39,000; Part time

Job summary

Randstad USA is seeking a detail-oriented Quality Improvement Specialist (Non-Clinical) for the HEDIS Season. This contract role focuses on pend management, medical records, and closing care gaps in a collaborative team.

You will handle daily pend status, provider outreach, and meticulous logging. Remote position with Arizona or Nevada residence required, 8:00 AM–5:00 PM AZ Time, Monday–Friday, with occasional overtime.

Qualifications

• At least 1 year of HEDIS experience preferred.
• 1 year of Pends / Medical Record Request experience preferred.
• Willing to train the right candidate who demonstrates strong foundational skills.

Responsibilities

• Pend Management & Resolution: Actively work and resolve assigned pends daily to secure records and close care gaps.
• Pend Code Interpretation: Understand pend codes and act per guidelines.
• Provider Outreach: Contact provider offices to request missing medical records.
• Record Tracking: Create, send, and track record requests through completion.
• Claims Research: Perform accurate claims research to support pend resolution.
• Detailed Status Tracking: Maintain detailed logs of daily activities and pend status.

Skills

HEDIS experience

Pends / Medical Records

Pend Codes

Provider outreach

Microsoft Excel

EMRs

Tools

Pends Portals

Smartsheet

Microsoft TEAMS

Excel

EMRs

QMRM

Job description

We are seeking a detail-oriented, punctual, and reliable Quality Improvement Specialist (Non-Clinical) to join a hard-working and collaborative team for the upcoming HEDIS Season (MY26). In this role, you will be assigned to the "Pends" Team, working closely with both clinical and non-clinical staff to secure medical records and close critical care gaps.

This is a dynamic contract opportunity where you will take ownership of daily pends status tracking, provider communication, and medical record request management within a supportive team environment.

• Position Type: Contract (Approximately 4 months)
• Pay Rate: $24.00 per hour
• Location: Remote (Candidates must reside in Arizona or Nevada)
• Schedule: Monday – Friday, 8:00 AM – 5:00 PM AZ Time (1-hour lunch). Occasional overtime may be required when approved by management.

Key Responsibilities

• Pend Management & Resolution: Actively work and resolve assigned pends in the provider portal system daily to secure required medical records and close care gaps.
• Pend Code Interpretation: Understand specific Pend codes and take swift, appropriate action based on internal guidelines.
• Provider Outreach: Contact provider offices and medical groups to request and obtain missing medical records necessary to complete the audit process.
• Record Tracking: Create, send, and diligently track medical record requests through completion.
• Claims Research: Perform accurate claims research to support pend resolution.
• Detailed Status Tracking: Maintain meticulously detailed logs of daily activities, progress, and pends status.

Performance Expectations

• Daily Resolution: Individual team members are assigned a list of pends to work and resolve daily. Expectations are to successfully complete all assigned pends by the end of each business day.

Qualifications & Skills

• Experience:
• At least 1 year of HEDIS experience preferred, OR
• 1 year of Pends / Medical Record Request experience preferred.
• Willing to train the right candidate who demonstrates strong foundational skills.
• Top Technical & Hard Skills:
• Knowledge of HEDIS Hybrid Measures.
• Proficiency across digital tools and platforms (Pends Portals, Smartsheet, Microsoft TEAMS, Excel, EMRs, and QMRM).
• Strong organizational skills with a proven track record of meeting daily deadlines.
• Soft Skills & Attributes: High attention to detail, strong work ethic, exceptional punctuality, and a collaborative mindset.