Remote Healthcare Data Auditor – HEDIS & Compliance

Health Care Service Corp.; United States; Remote; USD 63,000 - 114,000; Full time

Job summary

Health Care Service Corporation is seeking a quality-focused auditor to review electronic clinical records and oversee EMR data extraction. You will audit files for HEDIS and other quality measures, identify gaps in documentation, and support accreditation activities to ensure regulatory compliance.

The role emphasizes data integrity, industry-standard reporting, and collaboration with providers and vendors across multiple states.

Qualifications

• Bachelor’s degree or higher in a clinically related field.
• Knowledge of HEDIS reporting and software tools.
• Minimum of 3 year’s Healthcare industry experience; healthcare data
• Experience with NCQA and HEDIS reporting; data analysis in audit environments
• Understanding of claims, provider, and membership systems
• Knowledge of federal and state quality reporting and accreditation regulations
• Written, verbal, and interpersonal communication skills
• Self-starter with problem solving abilities
• PC proficiency to include Word, Excel, PowerPoint

Responsibilities

• Audit and review electronic clinical records to ensure regulatory and accrediting compliance.
• Oversee abstraction/extraction of clinical data from EMRs and audit supplemental files.
• Audit data for HEDIS, QRS and other quality measures; identify improvement opportunities.
• Contribute to integrity of Medical Record validation and HEDIS reporting.
• Support accreditation maintenance with national agencies.

Skills

HEDIS reporting

Data analysis

Audit environment

Claims & provider systems

Regulatory knowledge

Communication skills

Problem solving

Education

Bachelor’s degree or higher in a clinically related field

Tools

Word

Excel

PowerPoint

Job description

Health Care Service Corporation is seeking a quality-focused auditor to review electronic clinical records and oversee EMR data extraction. You will audit files for HEDIS and other quality measures, identify gaps in documentation, and support accreditation activities to ensure regulatory compliance.

The role emphasizes data integrity, industry-standard reporting, and collaboration with providers and vendors across multiple states.