Quality Audit Specialist

Job Title:
HEDIS Data Analyst (Clinical)
Location: Chicago, IL. Hybrid
Job Type: W2 Contract
Expected Hours per Week: 40 hours per week
Schedule: Monday–Friday, standard business hours
Pay Range: $40-$45 per hour

Position Description:
We are seeking a HEDIS Clinical Data Auditor to support data collection, validation, and compliance activities tied to HEDIS technical specifications. This role is responsible for auditing and reviewing electronic clinical records to ensure data accuracy and alignment with medical record documentation for regulatory reporting.

You will work across EMR and non-EMR data sources, including supplemental files from providers and vendors, to improve HEDIS rates and reporting outcomes. This position plays a key role in maintaining the integrity of the Medical Record Review (MRR) process and overall HEDIS reporting accuracy.

What You’ll Do:

• Perform HEDIS data abstraction, validation, and clinical record review.
• Audit EMR and non-EMR data to ensure compliance with HEDIS specifications.
• Review and validate supplemental data from providers and vendors.
• Ensure accuracy and completeness of medical record documentation.
• Support NCQA HEDIS reporting and audit processes.
• Investigate and resolve data discrepancies and collection issues.
• Apply HEDIS code sets and value sets appropriately.
• Collaborate with internal teams, providers, and vendors to improve data quality.
• Maintain documentation and reporting tied to HEDIS compliance standards.

Skills Required:

• Strong knowledge of HEDIS reporting and NCQA requirements.
• Experience with clinical quality auditing and medical record review.
• Understanding of HEDIS measures and technical specifications.
• Knowledge of coding/value sets including CPT II, SNOMED, LOINC, ICD, HCPCS.
• Strong proficiency in Microsoft Excel and reporting tools.
• Ability to multitask, prioritize, and work independently.
• Strong written and verbal communication skills.

Skills Preferred:

• Experience with HEDIS hybrid measures.
• Familiarity with payer or managed care environments.

Experience Required:

• Minimum 3 years of healthcare industry experience.
• Hands-on HEDIS data collection, abstraction, or reporting experience.
• Experience working in NCQA audit or formal HEDIS validation environments.
• Experience with EMR systems and clinical data analysis.

Even Better, You May Have:

• Certified Coding Certification (CPC, CCS, or similar).
• Experience working with supplemental/vendor data files.
• Strong problem-solving and data investigation experience.
• Proven ability to quickly learn new systems and tools.

Experience Preferred:

• 5+ years of HEDIS or clinical quality experience.

Education Required:

• High School Diploma or GED

Education Preferred:

• Bachelor’s Degree in Healthcare, Nursing, Health Information Management, or related field

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