Remote Quality Analyst, HEDIS & Population Health

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

Benefits offered by this job

401(k) plan

Benefits package

Remote work option

Competitive compensation

Job summary

CareFirst BlueCross BlueShield seeks an experienced Quality Analyst to support HEDIS, Stars, regulatory compliance, and population health initiatives across lines of business. The role involves retrieving and reviewing medical records, analyzing quality data, ensuring audit readiness, and driving initiatives that improve care quality and member outcomes.

The candidate will work remotely from the greater Baltimore/Washington area with periodic in-person meetings at CareFirst locations.

Qualifications

• Bachelor's degree in population health or related field.
• 3 years of professional experience in health insurance or related field.
• Experience with HEDIS, NCQA, CMS quality programs preferred.
• Data analytics experience with healthcare data, large data sets, dashboards, trackers, or reports.

Responsibilities

• Coordinate medical record retrieval and data activities for HEDIS, Stars, and regulatory reporting.
• Perform medical record abstraction, research, and quality review per HEDIS/NCQA specifications.
• Document findings, resolve pends, and maintain productivity, accuracy, and quality expectations.
• Support audit readiness and data integrity, including primary source verification and reconciliation of records.
• Analyze workflow, quality, and trends to identify improvement opportunities and guide gap-closure strategies.
• Maintain knowledge of HEDIS/NCQA/CMS standards and support training materials and SOPs.

Skills

Data analytics

SQL

Python

R

Microsoft Excel

Communication

Education

Bachelor's Degree in population health or related field

Tools

Cotiviti

Inovalon

Reveleer

Microsoft Office

Job description

CareFirst BlueCross BlueShield seeks an experienced Quality Analyst to support HEDIS, Stars, regulatory compliance, and population health initiatives across lines of business. The role involves retrieving and reviewing medical records, analyzing quality data, ensuring audit readiness, and driving initiatives that improve care quality and member outcomes.

The candidate will work remotely from the greater Baltimore/Washington area with periodic in-person meetings at CareFirst locations.