Full-time
Quality Improvement Specialist
Competitive
Full-time, ContractHealthcarePosted 19d ago
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Role overview
Job type
Salary
Competitive
Location
Sector
Posted
19 days ago
Job description
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
Preferred
At least 1 year of HEDIS experience or 1 year of medical record request / pends experience
Knowledge of HEDIS hybrid measures
Benefits
Work-from-home role
Medical, prescription, dental, vision, AD&D, and life insurance offerings (all benefits are based on eligibility)
Short-term disability (based on eligibility)
A 401K plan (based on eligibility)
Digital transformation and managed talent solutions provider.
Atlanta, Georgia, USA
https://www.randstaddigital.com
Distribution of Different Job Fields Receiving Sponsorship
94
Represents job field similar to this job
Engineering and Development
Management and Executive
Product Management
Customer Service and Support
Sales
Accounting and Finance
Creatives and Design
Marketing
Human Resources
Trends of Total Sponsorships
*2026
(712)
2025
(739)
2024
(821)
2023
(47)
Late Stage
Leadership Team
Qualifications
High School Diploma or equivalent required
Proficiency in using web portals and software, including TEAMS, Excel, Smartsheet, EMRs, and QMRM
Exceptional organizational, detail-oriented, and time-management skills
At least 1 year of HEDIS experience or 1 year of medical record request / pends experience
Knowledge of HEDIS hybrid measures
Required skills
HEDIS, HEDIS Hybrid Measures, Medical Record Retrieval, Pends, Microsoft Teams, Microsoft Excel, Smartsheet, QMRM, Quality Assurance
Preferred skills
Knowledge of HEDIS hybrid measures
Experience
2+ years
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