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Hedis Auditor Jobs (NOW HIRING)

Integrated Resources INC

HEDIS RN/LPN

Columbia, MD · On-site

$30 - $39.75/hr

A Special Project Nurse/Medical Professional will be responsible for completing auditing and/or ... Minimum RN associates degree, * LPN with strong HEDIS experience * Software skills are needed ...

w3r Consulting

Quality Audit Specialist

Chicago, IL · On-site

This position supports the data collection of HEDIS clinical data set tied to technical specifications; auditing and review of electronic clinical records to ensure data accurately reflect medical ...

MedKoder

Physician Coding Auditor

Mandeville, LA · Remote

Description: Physician Coding Auditor is responsible for reviewing and accurately coding all ... and HEDIS, as applicable; * Accurately score audits utilizing proper scoring methodology;

Imagine Pediatrics

Coding Compliance Auditor

OR · Remote

$75K - $90K/yr

What You'll Do The Coding Compliance Auditor partners cross-functionally with clinical leadership ... Strong understanding of HEDIS measures and E/M coding, with the ability to evaluate documentation ...

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How much do hedis auditor jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for hedis auditor in the United States is $30.10, according to ZipRecruiter salary data. Most workers in this role earn between $22.60 and $31.73 per hour, depending on experience, location, and employer.

What skills and qualifications are needed to be a Hedis auditor?

Hedis Auditors need a solid understanding of HEDIS measures, healthcare data abstraction, medical record review, and regulatory compliance—often supported by a background in nursing, health information management, or a related healthcare field. Familiarity with HEDIS software platforms, electronic medical record (EMR) systems, and sometimes certifications such as Certified Professional in Healthcare Quality (CPHQ) are highly valuable. Strong attention to detail, analytical thinking, and excellent organizational and communication skills help auditors navigate complex documentation and collaborate with clinical teams. Mastering these competencies is vital to ensure accurate reporting, facilitate quality improvement, and support compliance within healthcare organizations.

What are common challenges Hedis auditors face in their daily work?

Hedis Auditors often encounter challenges such as navigating incomplete or inconsistent medical records, managing large volumes of data within tight deadlines during the reporting season, and ensuring strict adherence to ever-evolving HEDIS guidelines. They may also face the need to collaborate with providers and office staff to retrieve additional documentation and clarify ambiguous entries. These obstacles require strong problem-solving skills and adaptability, making the role both demanding and professionally rewarding for those who enjoy detail-oriented work in a dynamic healthcare environment.

What is a Hedis auditor?

A HEDIS Auditor is a healthcare professional responsible for reviewing medical records and data to ensure compliance with the Healthcare Effectiveness Data and Information Set (HEDIS) measures. They analyze documentation from healthcare providers to validate coding accuracy and assess quality performance. Their role helps health plans meet regulatory requirements, improve patient outcomes, and achieve higher quality ratings. HEDIS Auditors must have a strong understanding of medical terminology, coding standards, and healthcare regulations.

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Hedis Auditor jobs near you
Infographic showing various Hedis Auditor job openings in the United States as of August 2026, with employment types broken down into 86% Full Time, 10% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 89% Physical, 5% Hybrid, and 6% Remote job distribution, with an average salary of $62,612 per year, or $30.1 per hour.

Auditor, Risk Adjustment Data Validation

University Health

San Antonio, TX • Remote

Full-time

Posted 27 days ago

University Of Nevada (Reno) rating

8.5

Company rating: 8.5 out of 10

Based on 18 frontline employees who took The Breakroom Quiz

80th of 618 rated colleges and universities

Job description

POSITION SUMMARY/RESPONSIBILITIES

The Risk Adjustment Data Validation (RADV) Auditor is responsible for auditing medical records to validate ICD-10-CM coding accuracy and ensure compliance with Centers for Medicare and Medicaid (CMS) and RADV guidelines. This role focuses on performing detailed audits, analyzing data, and collaborating with providers and internal teams to support Hierarchical Condition Categories (HCC) ratio goals and risk adjustment improvement initiatives. The auditor prepares customized reports based on data analysis and provides actionable recommendations to enhance operational and clinical performance. Additionally, the position assists in managing data collection processes and develops procedures for monitoring, validating, and reconciling data for accuracy. Working closely with cross-functional teams, the auditor supports compliance, quality assurance, and risk mitigation strategies while contributing to the development of tools and processes to improve coding accuracy and audit efficiency.

EDUCATION/EXPERIENCE

Bachelor’s degree required. Coding certification (such as CPC, CRC, or CCS) is preferred, or candidates must demonstrate a willingness to obtain certification within 6–12 months of hire. Applicants should have 1–2 years of healthcare experience; prior coding experience is preferred. Strong analytical and problem-solving skills, coupled with attention to detail, are essential. Candidates must possess the ability to learn and apply ICD-10-CM coding principles, exhibit excellent communication and organizational skills. Proficiency in health information systems, electronic health records (EHRs), HEDIS, RADV, and claims data analysis is a plus.

LICENSURE/CERTIFICATION

Coding certification within 2 years of employment (e.g., Certified Professional Coder - CPC, Certified Risk Adjustment Coder-CRC)

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