HEDIS Quality Specialist

Terms of Employment

• Contract, 5 Months
• This is primarily remote but hybrid. The resource is required to attend Training the week of December 14th at Merriweather and occasionally travel to provider sites

Overview

Our client is seeking HEDIS Quality Specialists to join their Quality Team and support their annual HEDIS project. This role involves assisting with medical record retrieval and abstraction and working closely with providers to ensure complete and accurate documentation. Ideal candidates will have a strong clinical background, critical thinking skills, and be comfortable analyzing medical records. Compliance with HIPAA and confidentiality standards is required, along with other duties as assigned. Applicants must be detail-oriented and able to work independently while maintaining a high level of accuracy.

We are seeking a qualified RN or LPN with experience supporting HEDIS reporting and abstraction processes in a payer, health insurance, or HEDIS vendor environment. The ideal candidate will understand NCQA healthcare quality metrics and have a proven ability to accurately abstract, interpret, and document medical record data for HEDIS gap closure

Position Overview

This role will support medical record retrieval, abstraction, pend management, overreads, and other key activities throughout the HEDIS project. The position will help enable the team to conduct the HEDIS Hybrid Project in-house. Additional support may include Risk Adjustment medical record retrieval, internal audits, and other identified operational needs

Training Details:

• Ideal candidates reside in or near MD, DC, VA, PA, or DE. Applicants must attend in-person training at CareFirst’s Merriweather office in December 2026, with exact dates to be provided.
• Candidates are responsible for any travel costs associated with attending this training.

Responsibilities

• Assist with the retrieval of medical records and abstraction of key information for HEDIS reporting.
• Analyze clinical records, identify missing information, and work with providers to gather required data.
• Shift from record retrieval to abstraction based on project needs.
• Request additional information from providers when necessary.
• Maintain accurate records and ensure compliance with HEDIS guidelines.

Required Skills & Experience

• Registered Health Information Associate/Registered Health Information Technician, Nursing, or a related clinical or healthcare field. Candidates qualifying in lieu of a degree must have 10 years of recent, directly relevant HEDIS medical record abstraction and/or overread experience within a payer, health insurance, or HEDIS vendor setting, including demonstrated knowledge of NCQA HEDIS specifications and abstraction platform workflows
• In Lieu of education, 10 years of recent HEDIS abstractions / overreads experience in the payer/health insurance side of HEDIS or with a HEDIS vendor (ex. Cotiviti, Inovalon, Reveleer)
• 3 years of clinical experience and 5 years of HEDIS experience.
• Experience with at least two HEDIS seasons as a Certified Medical Assistant or LPN
• Experience with medical record retrieval, HEDIS abstraction, and working within Electronic Medical Records (EMR) systems.
• Clinical background with strong critical thinking skills.
• Medical record analysis experience or clerical experience in a clinical setting.
• Open-minded, detail-oriented, and capable of working in a fast-paced environment.
• Strong communication skills, particularly with healthcare providers.
• Be detail-oriented, able to work independently, and maintain a high level of accuracy.
• Proficiency with Microsoft Office, including Excel, Word, PowerPoint, Microsoft Teams, and Outlook.
• Experience retrieving medical records from EMR platforms such as Epic, eClinicalWorks, Athena, Cerner, Allscripts, and Tebra is essential.
• Current knowledge of clinical practices related to HEDIS and medical record review.
• Strong organizational skills, including the ability to prioritize responsibilities, maintain attention to detail, and shift tasks as needed.
• Experience using Microsoft Office applications, including Excel, Word, and PowerPoint, as well as web-based technology.
• Excellent verbal and written communication skills.
• Strong interpersonal skills, with the ability to work independently and as part of a team

Preferred Skills & Experience

• Bachelor's degree in Nursing, Associates Degree in Nursing, Diploma in Nursing
• HEDIS overread experience with a health plan or HEDIS vendor is preferred