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 ensuring the audit and review of electronic clinical records to ensure they accurately reflect medical record documentation to meet regulatory and accrediting compliance mandates. This position will be responsible for oversight and review of the abstraction/extraction process of clinical data from Electronic Medical Records (EMRs); auditing supplemental files supplied by providers and vendors for HEDIS, QRS and other quality measures; identifying areas of opportunity to improve documentation and audit outcomes. This position impacts the integrity of the Medical Record validation process and HealthCare Effective Data & Information Set (HEDIS) Reporting. In addition, this position significantly contributes toward the achievement to maintenance of accreditation with national accreditation agencies.

Required Job Qualifications:

• Bachelor’s degree or higher in a clinically related field
• Knowledge of Healthcare Effective Data & Information Set (HEDIS*)* type of reporting and software tools
• Minimum of 3 year’s Healthcare industry experience; healthcare data
• Experience with NCQA and HEDIS reporting, technical data analysis in formal audit formal audit environment.
• Understanding of claims, provider, and membership systems, or similar database systems.
• Knowledge of federal and state quality reporting and accreditation, regulations for the health insurance industry (URAC, NCQA, ACA, State Depts of Insurance and/or comparable regulatory bodies
• Written, verbal, and interpersonal communication skills
• Self-starter with problem solving abilities.
• PC proficiency to include Word, Excel, PowerPoint

Preferred Job Qualifications:

• Registered Nurse (RN) with unrestricted license in state.
• Clinical quality auditing experience
• Proven to be adept at navigating new systems and technology with little impact to your daily agenda.
• Experience with Coding is highly preferred or Certified Coding Certification
• Strong Analytical Skills

This role is Telecommute (Remote)

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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

$63,300.00 - $114,300.00

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