Supplemental Data Auditor

Health Care Service Corp.; United States; Remote; USD 63,000 - 114,000; Full time

Job summary

Health Care Service Corporation is seeking a quality-focused auditor to review electronic clinical records and oversee EMR data extraction. You will audit files for HEDIS and other quality measures, identify gaps in documentation, and support accreditation activities to ensure regulatory compliance.

The role emphasizes data integrity, industry-standard reporting, and collaboration with providers and vendors across multiple states.

Qualifications

• Bachelor’s degree or higher in a clinically related field.
• Knowledge of HEDIS reporting and software tools.
• Minimum of 3 year’s Healthcare industry experience; healthcare data
• Experience with NCQA and HEDIS reporting; data analysis in audit environments
• Understanding of claims, provider, and membership systems
• Knowledge of federal and state quality reporting and accreditation regulations
• Written, verbal, and interpersonal communication skills
• Self-starter with problem solving abilities
• PC proficiency to include Word, Excel, PowerPoint

Responsibilities

• Audit and review electronic clinical records to ensure regulatory and accrediting compliance.
• Oversee abstraction/extraction of clinical data from EMRs and audit supplemental files.
• Audit data for HEDIS, QRS and other quality measures; identify improvement opportunities.
• Contribute to integrity of Medical Record validation and HEDIS reporting.
• Support accreditation maintenance with national agencies.

Skills

HEDIS reporting

Data analysis

Audit environment

Claims & provider systems

Regulatory knowledge

Communication skills

Problem solving

Education

Bachelor’s degree or higher in a clinically related field

Tools

Word

Excel

PowerPoint

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for ensuring the audit and review of electronic clinical records to ensure they accurately reflect medical record documentation to meet regulatory and accrediting compliance mandates. This position will be responsible for oversight and review of the abstraction/extraction process of clinical data from Electronic Medical Records (EMRs); auditing supplemental files supplied by providers and vendors for HEDIS, QRS and other quality measures; identifying areas of opportunity to improve documentation and audit outcomes. This position impacts the integrity of the Medical Record validation process and HealthCare Effective Data & Information Set (HEDIS) Reporting. In addition, this position significantly contributes toward the achievement to maintenance of accreditation with national accreditation agencies.

Required Job Qualifications

• Bachelor’s degree or higher in a clinically related field
• Knowledge of Healthcare Effective Data & Information Set (HEDIS) type of reporting and software tools
• Minimum of 3 year’s Healthcare industry experience; healthcare data
• Experience with NCQA and HEDIS reporting, technical data analysis in formal audit formal audit environment
• Understanding of claims, provider, and membership systems, or similar database systems
• Knowledge of federal and state quality reporting and accreditation, regulations for the health insurance industry (URAC, NCQA, ACA, State Depts of Insurance and/or comparable regulatory bodies)
• Written, verbal, and interpersonal communication skills
• Self-starter with problem solving abilities
• PC proficiency to include Word, Excel, PowerPoint

Preferred Job Qualifications

• Registered Nurse (RN) with unrestricted license in state
• Clinical quality auditing experience
• Proven to be adept at navigating new systems and technology with little impact to your daily agenda
• Experience with Coding is highly preferred or Certified Coding Certification
• Strong Analytical Skills

This role is Telecommute (Remote) #LI-Remote INJLF

Pay Transparency Statement

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From 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, we offer a robust total rewards package for employees. The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.

HCSC Employment Statement

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Base Pay Range

$63,300.00 - $114,300.00 Exact compensation may vary based on skills, experience, and location.

For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.

Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.