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Remote Dental Credentialing Specialist

Lombard, IL · Remote

$24/hr

Remote Dental Credentialing Coordinators Needed for Insurance Company Our client, a large national ... NCQA credentialing standards * Identify any discrepancies &conveys problems to Credentialing ...

Phsorg

... NCQA, contractual and regulatory quality requirements and measures for all lines of business ... Remote: Open to applicants in the United States, excluding CA, IL, ND, NY, WA, and WY. Hybrid: For ...

Sage Dental

Credentialing Specialist

Boca Raton, FL · On-site +1

Overview Sage is looking for a Delegated Credentialing Specialist (Remote) to join our team! The ... Adhere to NCQA guidelines. * Audit Provider Licensure Files to NCQA guidelines. * Pull Monthly ...

Molina Healthcare

Pharmacy CSR, Remote

Long Beach, CA · Remote

$17.50 - $23.75/hr

These positions are remote, however those in later time zones are encouraged to apply. This team ... Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other ...

Molina Healthcare

Pharmacy CSR, Remote

Long Beach, CA · On-site +1

$11.09 - $24.02/hr

These positions are remote, however those in later time zones are encouraged to apply. This team ... Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other ...

Healthcare Support Staffing

Remote HEDIS Specialist

OR · Remote

Remote worker with ability to read and write in Spanish and medical records. Under the direction of ... Assists as needed in support of accreditation activities such as NCQA reviews, CAHPS and state ...

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How much do remote ncqa jobs pay per year?

As of Jul 23, 2026, the average yearly pay for remote ncqa in the United States is $56,684.00, according to ZipRecruiter salary data. Most workers in this role earn between $41,000.00 and $61,000.00 per year, depending on experience, location, and employer.

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

AspectRemote NcqaRemote Medical Reviewer
Required CredentialsMedical license, NCQA certificationMedical license, specialty-specific certifications
Work EnvironmentHome-based, administrative tasks, data reviewHome-based, clinical review of medical records
Industry UsageHealthcare quality organizations, insurance companiesInsurance companies, healthcare providers
Common Search/ComparisonRemote Ncqa vs Remote Medical Reviewer

Remote Ncqa and Remote Medical Reviewer roles both involve healthcare quality and review tasks, often working from home. While both require medical credentials, Remote Ncqa focuses on healthcare quality standards and accreditation, whereas Remote Medical Reviewers primarily evaluate medical records for insurance claims or clinical accuracy. Understanding these differences helps job seekers identify roles aligned with their certifications and career goals.

What are the key skills and qualifications needed to thrive as a Remote NCQA (National Committee for Quality Assurance) professional, and why are they important?

To thrive as a Remote NCQA professional, you need a comprehensive understanding of healthcare quality standards, accreditation processes, and regulatory compliance, often supported by experience in healthcare administration or related certifications. Familiarity with NCQA guidelines, quality management software, and electronic health record (EHR) systems is typically required. Strong attention to detail, analytical thinking, and effective communication skills are crucial for success in remote environments. These skills ensure the accurate evaluation and implementation of quality standards, which are vital for maintaining accreditation and improving patient care outcomes.

What are remote NCQA jobs?

Remote NCQA jobs are positions that involve working from home or another remote location to support the standards and accreditation processes of the National Committee for Quality Assurance (NCQA). These roles often include responsibilities such as quality assurance, healthcare compliance, auditing, and documentation review for healthcare organizations. Remote NCQA professionals may work as auditors, consultants, or quality analysts, helping ensure healthcare organizations meet NCQA standards for accreditation. These jobs require knowledge of NCQA guidelines and strong attention to detail, as well as experience in healthcare administration or quality improvement.

What are some common challenges faced by professionals working remotely in NCQA-related roles, and how can they be addressed?

Professionals working remotely in NCQA (National Committee for Quality Assurance) roles often face challenges such as coordinating effectively with cross-functional teams, managing detailed documentation, and staying up-to-date with evolving accreditation standards. To address these, it’s important to leverage collaboration tools, establish regular virtual meetings, and maintain organized digital records. Staying engaged with professional development opportunities and NCQA updates can also help remote team members remain effective and compliant.
More about Remote Ncqa jobs
What cities are hiring for Remote Ncqa jobs? Cities with the most Remote Ncqa job openings:
What are the most commonly searched types of Ncqa jobs? The most popular types of Ncqa jobs are:
What states have the most Remote Ncqa jobs? States with the most job openings for Remote Ncqa jobs include:
What job categories do people searching Remote Ncqa jobs look for? The top searched job categories for Remote Ncqa jobs are:
Remote Ncqa jobs near you
Infographic showing various Remote Ncqa job openings in the United States as of July 2026, with employment types broken down into 6% Locum Tenens, 12% Internship, 2% As Needed, 66% Full Time, 4% Part Time, and 10% Nights. Highlights an 75% Physical, 3% Hybrid, and 22% Remote job distribution, with an average salary of $56,684 per year, or $27.3 per hour.
HEDIS Clinical Quality Analyst (Full Time, Remote, North Carolina Based)

HEDIS Clinical Quality Analyst (Full Time, Remote, North Carolina Based)

Alliance

Morrisville, NC • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 8 days ago

Job description

The HEDIS Clinical Quality Analyst provides clinical direction, guidance, training, and quality oversight for all things related to the clinical aspect of Healthcare Effectiveness Data and Information Set (HEDIS). This position would oversee abstraction, overreads and quality analysis of HEDIS for both Prospective and Retrospective Seasons to ensure the company complies with the standards set by the National Committee for Quality Assurance (NCQA) and Centers for Medicare & Medicaid Services (CMS). Performs quality improvement activities to monitor/maintain quality of care and compliance with applicable standards/regulations. Performs/coordinates HEDIS data collection, medical record review, and quality improvement activities as indicated.
This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to come into the Alliance Office for business and team meetings as needed.
Responsibilities & Duties
Oversight of HEDIS Projects
  • Subject matter expert (SME) for the National Committee for Quality Assurance (NCQA) HEDIS Measures. (Hybrid, Administrative and ECDS)
  • Review the quality of HEDIS internal processes/plans for alignment with procedures and/or best practices for supporting the HEDIS Team.
  • Responsible for participating in the development, research, and implementation of HEDIS improvement activities
  • Plan implementation of Primary Source Verification (PSV) and Medical Record Review Validation (MRRV) Audits
  • Oversees quality of abstraction, quality assurance (QA) and second level QA for HEDIS Hybrid Project and Supplemental Data Audit
  • Interpret qualitative and quantitative information and appropriately document findings
  • Make recommendations for improvement related to records reviewed and report findings
  • Identify system and/or operational issues hindering the attainment of quality performance standards as defined by NCQA, applicable state and Federal laws and regulations
  • Motivate, influence, and provide direction to staff assigned to the Hybrid and SDVA projects to ensure successful completion of project goals, deliverables, and timelines
  • Analyze and interpret technical specifications, business requirements, and regulatory guidance to support accurate implementation of HEDIS measures and project activities
  • Serve as a subject matter expert on NCQA and HEDIS resources, providing guidance, training, and consultation to project teams
  • Identify and escalate situations which may pose quality, compliance, and/or safety risks that may adversely affect the HEDIS Hybrid Audit, HEDIS Prospective Audit or SDVA Audit

Coordinate/Oversees Data Analysis and Quality Intervention and Report on Findings
  • Generate monthly/weekly HEDIS Quality reports on measure performance and submit to Directors, Managers, and Supervisors
  • Coordinates and oversees all quality management programs/projects ensuring compliance with all applicable regulatory bodies
  • Develops and implements quality management and error reduction programs as needed
  • Provide written feedback to Directors, Managers and Supervisors concerning quality concerns pertaining to individual performance, compliance risks/trends, root cause analysis and any system or process improvements recommendations related to the NCQA HEDIS measures

Effectively Measure the Key Output Variables to Ensure All Performance Changes are Accurately Assessed
  • Prepare analysis of initial and repeat HEDIS measures to evaluate efficacy of interventions and to improve approach for successfully resolving the root cause as needed
  • Evaluate validity and accuracy of supplemental data sources to draw appropriate conclusions

Analyze Changes in Performance to Determine the Impacts of Interventions
  • Perform any required data analysis to evaluate gaps in care
  • Prepare comprehensive reports to ensure adequate documentation and methodology to support findings and recommendations

Evaluate Knowledge Gaps of Staff and Coordinate Training
  • Creates/Updates HEDIS measure training manuals, tip sheets, measure assessments, pocket guides for HEDIS per NCQA Technical Specifications, annually
  • Conduct HEDIS measure training/testing yearly
  • Monitor training of staff for effectiveness and impact of outcomes from enhanced training

Minimum Requirements
Education & Experience
Required:
Graduation from an accredited school of nursing with a Registered Nurse (RN) license or Licensed Practical Nurse (LPN) and five (5) years of healthcare experience in HEDIS clinical quality and process improvement.
Additional Required Experience:
Experience with the NCQA Technical Specifications and Value Set Directory.
Experience with Medical Record Abstraction/Quality Analysis and oversight of HEDIS related duties for HEDIS to include the supplemental data audit, Prospective audit and Hybrid audit. Knowledge of NCQA Health Plan HEDIS data collection and reporting requirements and processes.
Understanding of the operational requirements for data collection in support of HEDIS or similar Quality programs.
Experience with the Medicaid population related to HEDIS Measures.
Preferred:
Data analysis and IT infrastructure of standard and non-standard data related to supplemental data experience.
Certified Professional in Healthcare Quality - CPHQ preferred.
Knowledge, Skills, & Abilities
  • Knowledge of North Carolina State and Federal rules and requirements related to the service continuum in North Carolina
  • Knowledge of Tailored Plan, Integrated Care and Care Management processes and regulatory requirements
  • Knowledge of best and promising practices for behavioral & physical health and/or intellectual/developmental disabilities
  • Microsoft Excel, Word, PowerPoint, SPSS, and Survey Monkey (or other online survey tool)
  • Strong clinical skills
  • Problem solving skills
  • Interpersonal Skills
  • Strong Analytical skills
  • Problem solving and conflict resolution skills
  • Strong diplomacy skills and discretion
  • Highly effective communication skills
  • Ability to negotiate and resolve issues with minimal assistance

Salary Range
$79,425 - $101,267/Annual
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity
An excellent fringe benefit package accompanies the salary, which includes:
  • Medical, Dental, Vision, Life, Long Term Disability
  • Generous retirement savings plan
  • Flexible work schedules including hybrid/remote options
  • Paid time off including vacation, sick leave, holiday, management leave
  • Dress flexibility

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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