HEDIS Reviewer / HEDIS Quality
Position: HEDIS Quality Audit/HEDIS Quality Nurse Coordinator Location: 100% Remote (USA) Work Schedule: Monday – Friday, 8:00 AM – 5:00 PM (local time) Job Overview: We are seeking experienced Healthcare Consultants to participate in HEDIS (Healthcare Effectiveness Data and Information Set) quality audits. The ideal candidates will review medical records, interpret clinical data, and ensure accurate documentation to support compliance with HEDIS and CMS performance measures. This is a fully remote opportunity, and training will be provided prior to assignment start. Key Responsibilities:
- Audit and overread medical record collection and review processes for HEDIS quality reporting.
- Review and interpret clinical criteria in medical records; annotate via Adobe PDF.
- Audit data in collection tools to ensure compliance with HEDIS/CMS standards.
- Maintain accurate and complete documentation to meet risk management, regulatory, and accreditation requirements.
- Participate in required training and project calls.
- Safeguard all confidential and protected health information (PHI) in accordance with HIPAA rules.
Qualifications:
- Required:
- 5+ seasons of HEDIS experience reviewing medical records.
- Prior experience performing chart audits.
- Strong knowledge of medical terminology and ability to read/interpret medical records.
- Proficiency in Microsoft Office Suite, Adobe PDF, and database systems.
- Excellent attention to detail, organizational, and time management skills.
- Professional communication skills and a strong work ethic.
- Preferred:
- RN/LVN with Associate or Bachelor’s degree (HEDIS experience may substitute for licensure).
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