Quality Audit Specialist

• 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

#LI-JV1