HEDIS Coordinator

Position Title : HEDIS Coordinator

Work Location : Remote

Assignment Duration : 6 Months

Work Schedule : 8 hours

Position Summary : Perform duties to ensure HEDIS data accuracy and reporting, including investigation, auditing, and improvement opportunities. Assist with quality improvement initiatives in the service and clinical areas.

Background & Context :

Needing a HEDIS Specialist to assist with record review and auditing through Q4 and into HEDIS Hybrid project. Our drive to is to reach the highest star rating for our plan. Must have HEDIS experience and HEDIS measure knowledge. Previous experience required. Any knowledge of QMRM and QCAT a bonus.

Key Responsibilities :

Coordinate, complete, and update management on clinical quality metrics and HEDIS processes and results

Establish and maintain an action plan to improve HEDIS scores

Implement process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities

Collaborate with providers and internal departments on rate investigation and validation activities, including maintaining all evidences, documentations, and changes

Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality

Qualification & Experience :

Bachelor's degree in related field or equivalent experience. 3+ years of quality improvement or healthcare related experience. Working knowledge of the National Committee on Quality Assurance (NCQA). HEDIS requirements preferred.

For the Nevada region only : Driver's license required.

For federal services only : Government Security / Clearance / US Citizenship Requirements

Typical Day in the Role :

8 hour days, no OT. Review 40-80 medical records for compliance and submit for HEDIS gap closure. Covers Medicaid, Medicare and Marketplace LOB. Will be fully integrated with other HEDIS staff. Work is remote. Must be driven and have a strong work ethic.

Compelling Story & Candidate Value Proposition :

Satisfaction of knowing our members are being taken care of by providers. Very strong team already in place with a great team collaboration environment.

Candidate Requirements :

Education / Certification

Required : Bachelor's Degree

Preferred : Licensure

Required : Preferred :

Years of experience required / Disqualifiers / Performance indicators

Must haves : Strong HEDIS knowledge, including measure knowledge

Nice to haves : Experience with QMRM / Inovalon and QCAT programs

Disqualifiers : No HEDIS or measure knowledge

Performance indicators : Strong work ethic. Must maintain a approval rate of 95% or higher for medical record reviews

Top 3 must-have hard skills (stack-ranked)

Strong HEDIS skills and Work Ethic

At least 3 years experience with HEDIS

Ability to work in a remote environment and complete set goals to drive results