Quality Improvement Specialist

Are you a detail-oriented healthcare professional looking for a work-from-home role supporting HEDIS operations? We are seeking a dedicated Quality Improvement Specialist to join our Pends team for the upcoming MY26 HEDIS season!

In this key remote role, you will work within provider portal systems to resolve pends, conduct claims research, and secure necessary medical records to close member care gaps. Working standard daytime hours (Monday through Friday, 8:00 AM – 5:00 PM AZ time), you will analyze pend codes, contact provider offices and medical groups, and track medical record requests to complete audit workflows. Expect to complete your daily assigned list of pends in a fast-paced, collaborative environment alongside clinical and non-clinical team members. If you bring strong computer proficiency, organizational skills, and a background in HEDIS, pends, or medical record retrieval, this seasonal contract assignment offers a great platform to make an impact.

salary: $24.12 - $24.13 per hour
shift: First
work hours: 8 AM - 5 PM
education: Bachelors

Responsibilities

Position Summary:

Resolve provider portal pends, perform claims research, and execute medical record requests to close care gaps and support seasonal HEDIS MY26 audit operations.

Key Responsibilities:

• Analyze and act upon pend codes in the provider portal system to secure missing medical records.

• Place outbound calls and send formal requests to provider offices and medical groups for record retrieval.

• Conduct claims research to identify missing clinical documentation needed for HEDIS audit completion.

• Log, monitor, and update daily pend status and record retrieval efforts in tracking systems (Smartsheet, Excel, EMRs).

• Complete all daily assigned pends by the end of each business day to meet seasonal audit timelines.

Requirements:

• High School Diploma or equivalent required.

• Preferred: At least 1 year of HEDIS experience or 1 year of medical record request / pends experience (willing to train qualified candidates).

• Knowledge of HEDIS hybrid measures preferred.

• Proficiency in using web portals and software, including TEAMS, Excel, Smartsheet, EMRs, and QMRM.

• Exceptional organizational, detail-oriented, and time-management skills.

• Must reside in Arizona or Nevada and be available for AZ time zone working hours.

Skills

• Basic Software Skills
• Medical Coursework
• Verbal Communication
• Quality Assurance

Qualifications

• Years of experience: 2 years
• Experience level: Experienced

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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on us.fitly.work.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.