Remote Quality Analyst - HEDIS & Data Quality

CareFirst; Baltimore (MD); Hybrid; USD 64,000 - 126,000; Full time

Job summary

CareFirst is seeking a Quality Analyst to support HEDIS, Stars, regulatory reporting, and population health initiatives. The role involves retrieving and reviewing medical records, analyzing quality data, and contributing to audit readiness across lines of business from a remote location within the Baltimore/Washington metro area.

The ideal candidate will have 3+ years of experience in healthcare or related fields, familiarity with HEDIS/NCQA, and strong data analytics skills using SQL, Python,

Qualifications

• Bachelor's degree or 4 years of relevant work experience in lieu of degree.
• 3 years of professional experience in a business environment (healthcare preferred).
• Certification in Quality or Process Improvement preferred.
• Experience with HEDIS, NCQA, CMS quality programs, Stars or related activities.
• Data analytics experience with healthcare data, dashboards, or reports.
• Experience with medical record retrieval and audit readiness workflows.
• Knowledge of HEDIS specifications and medical record review guidelines.
• Two consecutive HEDIS seasons with the same company preferred.

Responsibilities

• Coordinate medical record retrieval and provider outreach for HEDIS, Stars, and regulatory reporting.
• Perform medical record abstraction and quality review per HEDIS/NCQA specs.
• Document findings, resolve routine pends, and support quality processes.
• Support audit readiness and data integrity activities for medical record retrieval projects.
• Analyze workflow and trends to identify improvements and prepare actionable reports.
• Maintain knowledge of HEDIS, NCQA, CMS standards and HIPAA; assist with training materials.

Skills

Data analytics

SQL

Python

R

Excel

Communication

Education

Bachelor's degree in population health / related field

RN-BC certification (preferred)

Tools

Cotiviti

Inovalon

Reveleer

Microsoft Office

Job description

CareFirst is seeking a Quality Analyst to support HEDIS, Stars, regulatory reporting, and population health initiatives. The role involves retrieving and reviewing medical records, analyzing quality data, and contributing to audit readiness across lines of business from a remote location within the Baltimore/Washington metro area.

The ideal candidate will have 3+ years of experience in healthcare or related fields, familiarity with HEDIS/NCQA, and strong data analytics skills using SQL, Python,