Senior HEDIS Quality Audit Lead (RN/LPN)

Emploive; Northern (KY); Remote; USD 41,000 - 76,000; Full time

Benefits offered by this job

Health and wellness benefits

401(k) savings plan

Pension plan

Paid time off

Paid parental leave

Disability insurance

Supplemental life insurance

Employee assistance program

Paid holidays

Tuition reimbursement

Plus other incentives

Job summary

Health Care Service Corporation (HCSC) is seeking a licensed RN or LPN to join our quality audit team. The role focuses on evaluating requirements for HEDIS medical record review, data validation, and audit activities to ensure accuracy before production release.

The ideal candidate will possess strong clinical knowledge, experience with EMRs, and the ability to work independently in a remote setting while meeting productivity and quality targets.

Qualifications

• Bachelor’s degree in technology or business administration with 2 years of testing experience OR 4 years of testing experience.
• Clear verbal, written and interpersonal skills, including the ability to work in teams.
• Analytical and problem-solving skills with initiative and accountability.
• Knowledge of testing methodologies and the Software Development Life Cycle.
• Experience with automated testing tools.

Responsibilities

• Evaluate requirements for HEDIS medical record review, data validation, and quality auditing.
• Develop and execute audit strategies, conducting detailed reviews of medical records and HEDIS data.
• Identify discrepancies, document findings, and ensure adherence to HEDIS guidelines and quality standards.
• Collaborate with stakeholders to research, investigate, and resolve data issues while providing accurate status updates.

Skills

Testing experience

Communication

Analytical thinking

SDLC knowledge

Automated testing tools

Education

Bachelor’s degree in technology or business administration

Tools

Arcadia

Job description

Health Care Service Corporation (HCSC) is seeking a licensed RN or LPN to join our quality audit team. The role focuses on evaluating requirements for HEDIS medical record review, data validation, and audit activities to ensure accuracy before production release.

The ideal candidate will possess strong clinical knowledge, experience with EMRs, and the ability to work independently in a remote setting while meeting productivity and quality targets.