At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for evaluating requirements for HEDIS medical record review, data validation, and quality auditing activities prior to production release. Seeking licensed nurses, RN or LPN, with strong clinical knowledge and experience reviewing medical records for quality and compliance. Responsible for developing and executing audit strategies, conducting detailed reviews of medical records and HEDIS data, identifying discrepancies, documenting findings, and ensuring adherence to HEDIS guidelines and quality standards. Works closely with internal stakeholders to research, investigate, and resolve data issues while providing accurate audit status updates and reporting. Focuses on quality, accuracy, and continuous improvement efforts that support Star Rating performance. Requires broad knowledge of healthcare processes, electronic medical records, and quality programs, along with the ability to work independently, manage multiple priorities concurrently, and consistently meet established productivity and accuracy metrics in a remote environment.

Required Job Qualifications:

• 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

Preferred Job Qualifications:

• Current, unrestricted RN or LPN license.
• Experience performing HEDIS medical record review, abstraction, auditing, and data validation.
• Strong knowledge of HEDIS measures, quality improvement initiatives, and Star Ratings programs.
• Experience working with electronic medical records (EMR) and reviewing clinical documentation for compliance and quality reporting.
• Experience using Arcadia or similar population health and quality management platforms.
• Advanced proficiency with Microsoft Excel, including data review, analysis, and reporting.
• Demonstrated ability to work independently in a remote, self-directed environment.
• Proven ability to maintain a high level of accuracy in a metric driven environment, including meeting established quality standards.
• Strong attention to detail with experience performing high-volume audit or quality review work.
• Ability to manage competing priorities and meet deadlines during peak HEDIS audit seasons.
• Experience interpreting and applying changing regulatory, quality, or HEDIS guidelines.
• Experience supporting healthcare quality, population health, care management, provider engagement, or quality improvement programs.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From 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, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Base Pay Range

$30.45 - $54.98

Exact compensation may vary based on skills, experience, and location.