Lead Quality Review and Audit Coordinator, RN/LPN

🔥 15 hours ago

🇺🇸 United States – Remote

💵 $30 - $54 / hour

⏰ Full Time

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Health Care Service Corporation is an independent licensee of the Blue Cross Blue Shield Association, serving nearly 23 million people across the United States with a wide range of health benefit solutions. The company provides health coverage options for various groups, including employers, individuals, families, as well as Medicare and Medicaid plans. In addition to health insurance, HCSC offers services such as pharmacy solutions, life and dental insurance, and health data technology. With nearly a century of experience, HCSC is dedicated to improving access to quality care, enhancing health outcomes, and reducing costs while maintaining a deep commitment to its members and local communities.

📋 Description

• Evaluate requirements for HEDIS medical record review, data validation, and quality auditing activities before production release • Develop and execute audit strategies • Conduct detailed reviews of medical records and HEDIS data • Identify discrepancies and document findings • Ensure adherence to HEDIS guidelines and quality standards • Work with internal stakeholders to research, investigate, and resolve data issues • Provide accurate audit status updates and reporting • Support Star Rating performance through quality and continuous improvement efforts • Work independently, manage multiple priorities, and meet productivity and accuracy metrics in a remote environment

🎯 Requirements

• 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 • Current, unrestricted RN or LPN license preferred • Experience performing HEDIS medical record review, abstraction, auditing, and data validation preferred • Strong knowledge of HEDIS measures, quality improvement initiatives, and Star Ratings programs preferred • Experience working with electronic medical records (EMR) and reviewing clinical documentation for compliance and quality reporting preferred • Experience using Arcadia or similar population health and quality management platforms preferred • Advanced proficiency with Microsoft Excel, including data review, analysis, and reporting preferred • Ability to work independently in a remote, self-directed environment preferred • Ability to maintain a high level of accuracy in a metric-driven environment, including meeting established quality standards preferred • Strong attention to detail with experience performing high-volume audit or quality review work preferred • Ability to manage competing priorities and meet deadlines during peak HEDIS audit seasons preferred • Experience interpreting and applying changing regulatory, quality, or HEDIS guidelines preferred • Experience supporting healthcare quality, population health, care management, provider engagement, or quality improvement programs preferred • Successful completion of drug screening may be required • Must work remotely from within the continental United States, excluding California, New York, Alaska, and Hawaii

🏖️ Benefits

• Curated development plans and professional development opportunities • 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 • Annual incentive bonus plan • Other incentives