Remote Quality Analyst – HEDIS & Data Quality

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

Benefits offered by this job

Travel opportunities

Job summary

CareFirst BlueCross BlueShield in the Baltimore/Washington metro area seeks a Quality Analyst to support HEDIS, Stars, regulatory reporting, and population health initiatives. Responsibilities include medical record retrieval, data analysis, audit readiness, and process improvement across lines of business.

The role offers remote work from within the metro area with periodic on-site meetings for training and collaboration, and requires coordination with internal teams, vendors, and provider

Qualifications

• Education: Bachelor's Degree or 4 years of relevant work experience.
• RN-BC licensure preferred.
• 3 years of professional experience in a business environment (healthcare or related fields preferred).
• Experience with HEDIS/NCQA/CMS quality programs is a plus.

Responsibilities

• Coordinate medical record retrieval, provider outreach, intake, upload, routing, follow-up, and documentation for HEDIS and related programs.
• Perform medical record abstraction and quality review per HEDIS/NCQA specs.
• Document findings, resolve routine pend items, and support audit readiness activities.
• Analyze workflow and trends to identify improvement opportunities; prepare summaries for teams.
• Maintain knowledge of HEDIS, NCQA, CMS standards, HIPAA, and quality operations.
• Assist in development of training materials and SOPs.

Skills

Data analytics

SQL

Python

R

Excel

Education

Bachelor's Degree in population health, public health, healthcare administration, business administration, health policy, economics, statistics, mathematics, data science, or related field

Tools

Cotiviti

Inovalon

Reveleer

Microsoft Office

Job description

CareFirst BlueCross BlueShield in the Baltimore/Washington metro area seeks a Quality Analyst to support HEDIS, Stars, regulatory reporting, and population health initiatives. Responsibilities include medical record retrieval, data analysis, audit readiness, and process improvement across lines of business.

The role offers remote work from within the metro area with periodic on-site meetings for training and collaboration, and requires coordination with internal teams, vendors, and provider