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Remote Hedis Reviewer Jobs in Virginia (NOW HIRING)

Sentara Healthcare

IT HEDIS & Analytics Manager

Norfolk, VA · On-site +1

$29.25 - $38.75/hr

Overview The IT HEDIS Manager is responsible for leading the technology, data integration, platform ... For positions that are available as remote work, Sentara Health employs associates in the following ...

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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 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.

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.

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For Remote Hedis Reviewer jobs in Virginia, the most frequently searched job titles are:

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The top searched job categories for Remote Hedis Reviewer jobs in Virginia are:

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Cities in Virginia with the most Remote Hedis Reviewer job openings:

Remote Hedis Reviewer jobs near you

IT HEDIS & Analytics Manager

Sentara Healthcare

Norfolk, VA • On-site, Remote

$29.25 - $38.75/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 25 days ago

Sentara Health rating

6.7

Company rating: 6.7 out of 10

Based on 412 frontline employees who took The Breakroom Quiz

534th of 893 rated healthcare providers

Job description

City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Overview
The IT HEDIS Manager is responsible for leading the technology, data integration, platform operations, and technical validation functions that support the organization's HEDIS program. This role manages ETL developers and operational support staff while serving as a key IT partner to HEDIS, Quality, business, vendor, audit, and project stakeholders. The manager oversees HEDIS data feeds, production operations, platform support, data-quality controls, technical documentation, vendor coordination, audit support, and reporting deliverables. This role will also support a major HEDIS engine replacement initiative, including migration from the current Inovalon/Cotiviti environment to a future-state platform with Arcadia supporting portions of HEDIS and NCQA-related functionality.
Education
  • Bachelor's degree in Information Technology, Computer Science, Data Management, Healthcare Administration, or a related field (Preferred)
or
  • 7+ years relevant experience may be accepted in lieu of degree

Certification/Licensure
  • No specific certification or licensure requirements

Experience
  • Seven or more years of experience in healthcare data, payer technology, analytics, data warehousing, quality measurement, HEDIS operations, or related IT functions (required )
  • Three or more years of leadership experience managing ETL, data engineering, technical operations, analytics, production support, or similar teams, including direct oversight of staff (required)
  • Experience supporting HEDIS data processing, reporting, validation, audits, quality-measurement platforms, or HEDIS engine implementation, replacement, migration, or parallel-validation activities(Required)
  • Strong knowledge of payer enrollment, claims, encounters, pharmacy, provider, laboratory, clinical, supplemental data, ETL, SQL, data warehouses, Databricks, file-based integrations, APIs, testing, reconciliation, and production support.
  • Experience working with HEDIS-related vendors or platforms such as Arcadia, Cotiviti, Inovalon, or comparable systems, with the ability to communicate technical issues clearly to business, vendor, audit, project, and executive stakeholders.(preferred)
  • Experience supporting an NCQA HEDIS compliance audit.(preferred)
  • Knowledge of ECDS, digital HEDIS measures, FHIR, HIE integration, and clinical-data exchange

Keywords: LinkedIn , HEDIS, Cotiviti, Innovalan,Arcadia
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to 10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - 5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - 10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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