Senior Quality Audit Lead - RN/LPN (Remote)

HCSC Group; United States; Remote; USD 70,000 - 100,000; Full time

Job summary

Health Care Service Corporation is seeking a Lead Quality Review and Audit Coordinator (RN/LPN) to evaluate HEDIS medical record review, data validation, and quality auditing in a remote, distributed environment.

You will develop and execute audit strategies, review medical records and HEDIS data, identify discrepancies, and report status to stakeholders while ensuring adherence to HEDIS guidelines and supporting Star Rating performance.

Qualifications

• Bachelor’s degree in technology or business administration with 2 years of testing experience OR 4 years of testing experience.
• Clear and concise verbal, written and interpersonal skills, including teamwork.
• 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 before production release.
• Develop and execute audit strategies and conduct detailed reviews of medical records and HEDIS data.
• Identify discrepancies, document findings, and ensure adherence to HEDIS guidelines and quality standards.
• Collaborate with internal stakeholders to research, investigate, and resolve data issues and provide audit status updates.

Education

Bachelor’s degree in technology or business administration

2+ years testing experience OR 4 years testing experience

Tools

Arcadia

Job description

Health Care Service Corporation is seeking a Lead Quality Review and Audit Coordinator (RN/LPN) to evaluate HEDIS medical record review, data validation, and quality auditing in a remote, distributed environment.

You will develop and execute audit strategies, review medical records and HEDIS data, identify discrepancies, and report status to stakeholders while ensuring adherence to HEDIS guidelines and supporting Star Rating performance.