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Remote Hedis Reviewer Jobs in Indiana (NOW HIRING)

Urrly

Telehealth Nurse Practitioner

Indianapolis, IN · Remote

$600 - $720/day

Close HEDIS care gaps during visits * Review medical history, medications, and preventive needs ... Fully remote work - no commute * Consistent visit flow and structured workflows * Clear ...

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Remote Hedis Reviewer information

What is a remote HEDIS reviewer?

A Remote HEDIS Reviewer is a healthcare professional who evaluates medical records and data from a remote location to ensure compliance with HEDIS (Healthcare Effectiveness Data and Information Set) measures. HEDIS is a set of standardized performance measures used to assess the quality of care and services in health plans. Remote HEDIS Reviewers typically review patient charts, extract relevant information, and record their findings in electronic systems. Their work helps health plans report accurate quality data, meet regulatory requirements, and improve patient care. This role often requires experience in nursing, coding, or healthcare data analysis, as well as familiarity with medical terminology and electronic health records.

What is the difference between Remote Hedis Reviewer vs Remote Medical Reviewer?

AspectRemote Hedis ReviewerRemote Medical Reviewer
Required CredentialsRN, LPN, or other healthcare certificationsMD, DO, or advanced healthcare certifications
Work EnvironmentHome-based, reviewing healthcare records for Medicaid/MedicareHome-based, reviewing medical records for insurance or legal cases
Employer & Industry UsageHealth plans, Medicaid/Medicare providersInsurance companies, legal firms, healthcare organizations
Common Search & ComparisonYesYes

The main difference is that Remote Hedis Reviewers typically hold nursing or healthcare certifications and focus on Medicaid/Medicare compliance reviews, while Remote Medical Reviewers often have medical degrees and handle broader medical record assessments for insurance or legal purposes. Both roles are home-based and require healthcare expertise, but they serve different industry needs.

What does a remote HEDIS reviewer do?

A typical day for a Remote HEDIS Reviewer involves reviewing and abstracting medical records to ensure compliance with HEDIS quality measures, documenting findings in electronic systems, and meeting productivity and accuracy targets. Communication and collaboration are primarily managed via secure digital platforms—such as email, video meetings, and instant messaging—enabling regular check-ins with team leads and peers. While much of the work is independent, reviewers often participate in virtual team meetings to discuss updates, share best practices, and address any challenges. Time management and self-motivation are essential, as is the ability to adapt to evolving guidelines and tight deadlines during the HEDIS season.

What skills and qualifications are needed to thrive as a remote HEDIS reviewer?

To thrive as a Remote HEDIS Reviewer, you need a background in healthcare, strong knowledge of HEDIS measures, and experience with medical record review, often supported by an RN or LPN license. Familiarity with HEDIS abstraction software, electronic medical records (EMRs), and secure data management systems is typically required. Exceptional attention to detail, time management, and strong written communication are critical soft skills for excelling in this remote role. These skills ensure accurate data abstraction, compliance with regulatory standards, and effective contribution to quality improvement initiatives.
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Remote Hedis Reviewer jobs near you

Certified Medical Assistant - Clinical Quality Specialist

SIHO HOLDING INC

Indianapolis, IN • On-site, Remote

$35 - $46.50/hr

Other

This job post has expired today. Applications are no longer accepted.

Job description

Job Title: CMA - Clinical Quality Specialist 

Reports to: Director, Medical Management 
**Not open to remote, qualified candidates must reside in Indianapolis, IN

The Clinical Quality Specialist supports the Clinical Quality Nurse in overseeing the HEDIS quality collection, submission, reporting, and auditing as well as assists with education to support the MyTruAdvantage line of business. 

Key Responsibilities: 

  • Knowledge of current HEDIS guidance, hybrid measure reporting, and measure compliance requirements.  

  • Collaborate with Clinical Quality Nurse and internal data analyst to oversee HEDIS quality gap distribution to health partners and member providers for HEDIS clinical data collection. 

  • Participate in communication with health partners regarding process of clinical document submission, annual education on applicable HEDIS measures, and cadence of reporting.  

  • Help identify opportunities for improved or expanded HEDIS data collection.  

  • Participate in internal chart chasing efforts.  

  • Assure proper internal secure storage of HEDIS data collected from external providers. 

  • Participate in Medical Record Review clinical submissions processes, assuring accuracy and completeness. 

  • Support outreach efforts to external providers to collect clinicals needed for reporting. 

  • Assist with maintaining all HEDIS related guidelines, policy & procedures, and auditing documents necessary for successful annual HEDIS audits. 

  • Active participant in any external HEDIS audits performed as needed.  

  • Support internal Chronic Care Improvement Program initiatives as needed. 

  • Participate in internal or external process improvement efforts that support the quality improvement and collection efforts necessary for the Medicare Advantage or commercial lines of business. (Accurate provider attributions, training of health partners, training of new internal staff etc.) 

Minimum Skills Requirement:

  • CMA or experience in clinical documentation review preferred.

  • Experience in working for or with HEDIS data collection and reporting preferred.

  • Proficiency in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint).

  • Experience with electronic medical records and using online tools.

  • Ability to communicate professionally with physicians and office staff to facilitate organizational initiatives.

  • Willingness to obtain applicable HEDIS certifications deemed appropriate for position.

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