[Hiring] Lead Quality Review and Audit Coordinator @Health Care Service Corporation

Role Description

This position is responsible for evaluating requirements for HEDIS medical record review, data validation, and quality auditing activities prior to production release. Seeking licensed nurses, RN or LPN, with strong clinical knowledge and experience reviewing medical records for quality and compliance.

• Responsible for developing and executing audit strategies.
• Conducting detailed reviews of medical records and HEDIS data.
• Identifying discrepancies and documenting findings.
• Ensuring adherence to HEDIS guidelines and quality standards.
• Works closely with internal stakeholders to research, investigate, and resolve data issues.
• Providing accurate audit status updates and reporting.
• Focuses on quality, accuracy, and continuous improvement efforts that support Star Rating performance.
• Requires broad knowledge of healthcare processes, electronic medical records, and quality programs.
• Ability to work independently, manage multiple priorities concurrently, and consistently meet established productivity and accuracy metrics in a remote environment.

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 the ability to work in teams.
• Analytical and problem-solving skills coupled with initiative and accountability.
• Knowledge of testing methodologies and the Software Development Life Cycle.
• Experience with automated testing tools.

Requirements

• Current, unrestricted RN or LPN license.
• Experience performing HEDIS medical record review, abstraction, auditing, and data validation.
• Strong knowledge of HEDIS measures, quality improvement initiatives, and Star Ratings programs.
• Experience working with electronic medical records (EMR) and reviewing clinical documentation for compliance and quality reporting.
• Experience using Arcadia or similar population health and quality management platforms.
• Advanced proficiency with Microsoft Excel, including data review, analysis, and reporting.
• Demonstrated ability to work independently in a remote, self-directed environment.
• Proven ability to maintain a high level of accuracy in a metric driven environment, including meeting established quality standards.
• Strong attention to detail with experience performing high-volume audit or quality review work.
• Ability to manage competing priorities and meet deadlines during peak HEDIS audit seasons.
• Experience interpreting and applying changing regulatory, quality, or HEDIS guidelines.
• Experience supporting healthcare quality, population health, care management, provider engagement, or quality improvement programs.

Benefits

• 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.
• Other incentives.

Company Description

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.

This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.