HEDIS Quality Specialist

7 days ago


Baltimore, Maryland, United States ALTA IT Services, LLC Full time
HEDIS Quality Specialist Job Description

ALTA IT Services, LLC is seeking a skilled HEDIS Quality Specialist to support a leading health insurance customer. The ideal candidate will have extensive knowledge of HEDIS measures and medical record review processes.

Key Responsibilities:
  • Retrieve medical records via EMR or fax request, ensuring compliance with HIPAA and member confidentiality requirements.
  • Conduct thorough medical record reviews using proprietary tools and software.
  • Abstract medical records for gap closure and additional data gathering.
  • Utilize expertise in HEDIS and Quality Measures to meet productivity and quality targets.
  • Ensure compliance with NCQA guidelines and technical specifications.
Requirements:
  • At least two consecutive HEDIS seasons.
  • Two years clinical experience and good understanding of medical terminology.
  • Strong interpersonal skills and ability to work independently.
  • Current knowledge of clinical practices and related medical policies.
  • Experience in using Microsoft Office and web-based technology.

Benefits: Competitive hourly rate of $29, 90% remote work arrangement, and one week of training onsite.

Qualifications: LPN or Certified Medical Assistant required.



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