Job Description

Job Description:

Job Tittle: Quality Improvement Specialist (HEDIS)

Location: Remote

Duration: 6 Months (Possible Extensions & Conversion)

Shift: 9 AM 5 PM Monday to Friday

Position Overview

The Quality Improvement Specialist (HEDIS) supports the health plan in executing medical record reviews, HEDIS chart abstraction, and quality improvement projects. This role plays a key part in ensuring accurate and timely data collection to support care gap closure and enhance quality performance outcomes.

The position is ideal for individuals with prior experience in HEDIS data abstraction, medical record review, or provider outreach who are detail-oriented and thrive in a fast-paced, collaborative remote environment.

Key Responsibilities

• Conduct HEDIS hybrid chart abstraction and data validation with accuracy and timeliness.

• Perform medical record reviews, ensuring completeness, compliance, and documentation accuracy.

• Support chart chase activities by contacting providers and collecting necessary medical records.

• Enter abstracted data into HEDIS software platforms accurately using Adobe Acrobat and Excel.

• Analyze and track data for quality improvement initiatives and reporting purposes.

• Collaborate with health plan staff, providers, and internal teams to resolve data discrepancies.

• Assist in training and audit processes related to medical record abstraction and over-read activities.

• Monitor contractual quality indicators and assist in preparing quality improvement plans (PIPs).

• Ensure compliance with NCQA and HEDIS documentation standards.

Required Qualifications

• Education: High School Diploma or equivalent required. Bachelor's in Nursing, Healthcare, or Quality preferred.

• Experience:

  • Minimum 1 year of HEDIS experience including medical record review or abstraction.

  • Proficiency in Adobe Acrobat and data entry in HEDIS platforms.

  • Familiarity with medical terminology, clinical documentation, and NCQA standards.

• Technical Skills:

  • Intermediate to advanced proficiency in Excel and Microsoft Office Suite.

  • Experience with QMRM or other abstraction systems preferred.

• Soft Skills:

  • Excellent attention to detail and accuracy.

  • Strong written and verbal communication.

  • Ability to work independently while meeting production goals and turnaround times.

Performance Indicators

• Ability to process a minimum of 6 medical records per hour.

• Maintain compliance with all SLA timelines for provider outreach and chart review.

• High accuracy in data validation and abstraction.

Team & Environment

You'll be part of a collaborative, cross-functional team that emphasizes:

• Open communication and transparent collaboration.

• Professional growth and adaptability.

• A mission-driven culture focused on improving care quality and member outcomes.

Candidate Value Proposition

This position offers:

• Hands-on experience supporting one of the nation's largest managed care organizations.

• Exposure to HEDIS abstraction, quality metrics, and healthcare performance data.

• Opportunity to advance skills in quality improvement and data analytics.

• Flexible remote work with meaningful contributions to care quality initiatives.

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