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Quality Audit Specialist

Epitec

Chicago, IL

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JOB DETAILS
SALARY
$42–$44 Per Hour
SKILLS
Analysis Skills, Auditing, Certified Coding Specialist (CCS), Clinical Data, Clinical Validation, Communication Skills, Current Procedural Terminology (CPT), Data Analysis, Data Collection, Data Quality, Data Sets, Documentation, Electronic Medical Records, Health Plan, Healthcare, Healthcare Common Procedure Coding System (HCPCS), Healthcare Effectiveness Data and Information Set (HEDIS), Healthcare Quality, International Classification of Diseases (ICD), Maintain Compliance, Managed Care, Medical Records, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Microsoft Word, Multitasking, National Committee for Quality Assurance (NCQA), Presentation/Verbal Skills, Quality Management, Quality Metrics, Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Regulatory Compliance, Regulatory Requirements, Reporting Skills, Systems Analysis, Writing Skills
LOCATION
Chicago, IL
POSTED
2 days ago
  • Location: Chicago, Illinois
  • Type: Contract
  • Job #104624
Job Title: HEDIS Clinical Data Auditor
Location: Hybrid, Chicago, IL
Pay Rate: $42 - 44 Per Hour
Job Type: W2 Contract
Expected Hours per Week: 40
Schedule: Monday-Friday, 8:00 AM-5:00 PM

Position Description:
This position supports the collection, validation, and auditing of HEDIS clinical data to ensure compliance with NCQA technical specifications and regulatory requirements. The role is responsible for reviewing medical records, auditing EMR and supplemental data sources, validating healthcare quality data, and supporting HEDIS reporting activities. This position plays a critical role in maintaining the integrity of the Medical Record Validation process and ensuring accurate HEDIS reporting.

Key Responsibilities:
  • Perform HEDIS medical record reviews and clinical data abstraction.
  • Audit and validate clinical data from EMRs, provider records, vendors, and supplemental data sources.
  • Analyze healthcare data to ensure compliance with NCQA HEDIS technical specifications.
  • Review and validate HEDIS quality measures, code value sets, and reporting requirements.
  • Conduct investigations related to medical record data collection and quality reporting issues.
  • Ensure data accuracy and integrity throughout the Medical Record Validation process.
  • Collaborate with providers, vendors, and internal stakeholders to improve HEDIS outcomes.
  • Analyze and interpret coding systems including CPT II, SNOMED, LOINC, ICD, and HCPCS.
  • Prepare reports, documentation, and audit findings.
  • Utilize Microsoft Office tools and reporting systems to analyze datasets and track results.
Required Qualifications:
  • Minimum of 3 years of healthcare industry experience with healthcare data.
  • Direct experience with HEDIS reporting and NCQA technical specifications.
  • Experience reviewing and auditing clinical records in a formal audit environment.
  • Strong understanding of Electronic Medical Records (EMRs).
  • Experience with HEDIS code sets including CPT II, SNOMED, LOINC, ICD, and HCPCS.
  • Strong analytical, written, and verbal communication skills.
  • Proficiency with Microsoft Excel, Word, PowerPoint, and reporting tools.
  • Ability to manage multiple priorities with minimal supervision.
Preferred Qualifications:
  • CPC, CCS, RHIT, RHIA, or similar coding certification.
  • Experience supporting health plan or managed care HEDIS audits.
  • Experience with provider and vendor supplemental data submissions.
  • Healthcare quality improvement experience.
Top Skills:
  • HEDIS Reporting
  • NCQA Compliance
  • Medical Record Review
  • Clinical Data Auditing
  • HEDIS Abstraction
  • EMR Review
  • CPT II / ICD / HCPCS / SNOMED / LOINC
  • Healthcare Data Analysis
  • Microsoft Excel
  • Quality & Regulatory Compliance

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About the Company

E

Epitec

Epitec is a leading staffing and recruiting services company with a mission to make staffing personal. We go beyond traditional hiring by truly understanding our candidates and matching them with the perfect opportunities. We offer competitive compensation, career growth, and support throughout the entire process. Working with top Fortune 500 companies, we are recognized for our excellence with numerous awards, including Best & Brightest and diversity recognitions. At Epitec, we're redefining the future of employment. 

COMPANY SIZE
2,500 to 4,999 employees
INDUSTRY
Staffing/Employment Agencies
EMPLOYEE BENEFITS
Professional Development, 401K, Employee Referral Program, Life Insurance
FOUNDED
1978
WEBSITE
https://epitec.com/

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