Lead Quality Review and Audit Coordinator, RN/LPN

Health Care Service Corporation

. Evaluate requirements for HEDIS medical record review, data validation, and quality auditing activities before production release .

Posted 10/5/2026full-timeRemote • United StatesSenior💰 $30 - $55 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in HEDIS medical record review, data validation, and quality auditing, with a strong focus on adherence to guidelines and quality standards. Proficient in using automated testing tools and Microsoft Excel for data analysis and reporting in a remote, metric-driven environment.

Highest-signal resume keywords

HEDIS Medical Record ReviewAutomated Testing ToolsMicrosoft Excel ProficiencyQuality Improvement InitiativesData Validation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data ValidationQuality AuditingTesting MethodologiesSoftware Development Life CycleHEDIS MeasuresElectronic Medical RecordsClinical Documentation ReviewAudit StrategiesData AnalysisRegulatory Compliance

Soft Skills

Analytical SkillsProblem-Solving SkillsVerbal CommunicationWritten CommunicationInterpersonal Skills

Tools & Technologies

ArcadiaPopulation Health PlatformsQuality Management Platforms

Certifications & Qualifications

RN LicenseLPN License

Industry Keywords

HEDIS GuidelinesStar Ratings ProgramsHealthcare QualityPopulation HealthCare Management

Tech Stack

Tools & technologies

SDLC

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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