HEDIS Specialist - REMOTE

Our client, one of the largest healthcare corporations, is seeking a large number of HEDIS Specialists to support to support quality assurance activities related to HEDIS quality measures for 2027.

Contract Job: W-2 - Remote in US ONLY!

Schedule: Monday-Friday, 8:00 AM-5:00 PM EST

Assignment Commitment: January 2027 to April 2027, with minimal to no absences

Pay Rate: $35 to $42 per hour *Pay offered is based on experience, expertise, credentialing, and education.

Key Responsibilities:

• Perform medical record reviews and overreads for HEDIS and HEDIS-like measures.
• Verify clinical data and meet established production goals.
• Research non-compliant member records and identify supporting documentation.
• Maintain HIPAA compliance and confidentiality of protected health information.
• Communicate questions and concerns to the Contractor Supervisor or assigned Specialist.
• Participate in team meetings and provide updates on clinical reviews.
• Complete HEDIS technical specification training/testing with a 95% or higher passing score.
• Complete required software training and accurately use applicable systems.
• Conduct provider outreach and medical record requests as needed.
• Perform other duties as assigned.

Qualifications and Experience:

• 1+ year of HEDIS and/or medical record review experience preferred.
• 1+ year of healthcare, health plan, or managed care experience preferred.
• Experience with abstraction and overread.
• HEDIS experience with BPD, CBP, COA, HBD, DVSCH, PPC, TRC, or WCC preferred.
• LTSS, FFR, and FFS experience is a plus.
• Strong critical thinking, organizational, and time-management skills.
• Adaptable, coachable, and able to work independently.
• Intermediate proficiency with Word, Excel, Adobe, and PowerPoint.
• RN, LPN, or LVN preferred but not required.
• Reliable high-speed internet and a designated home workspace required.

Interested? Apply Today!

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For workers in the United States, PrideGlobal and it's affiliates offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, pet insurance and employee discounts with preferred vendors.

Equal Employment Opportunity

PrideGlobal and it's affiliates are an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Fair Chance Employment

PrideGlobal and it's affiliates are a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.

Accommodations

We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

Only applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.

Only applicable for Kentucky positions: For this type of employment, state law requires a criminal record check as a condition of employment. This applies to direct care staff (Examples: RN, LPN, Nurse Aides, Therapists) referred to Kentucky nursing facilities, assisted living communities, or long-term care facilities, in accordance with KRS 216.793.