Quality Improvement Specialist (HEDIS)

Immediate need for a talented Quality Improvement Specialist (HEDIS). This is a 04+months contract opportunity with long-term potential and is located in TX(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID : 25- 90317

Pay Range : $20 - $21 / hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities :

• NOTE- Remote- Candidate must be local to TX.
• The HEDIS non-clinical team falls under the Quality Improvement Department of the Health Plan in Texas.
• Most of our project’s center on monitoring HEDIS rates all throughout the year, medical record retrieval, and reporting for our internal stakeholders in the health plan.
• We will be working with a medical record retrieval vendor who will encounter barriers to retrieval during season and will “pend” these chases to the health plan for resolution.
• The QI Specialist will resolve these “pends” and ensure that we receive the records which will contribute to member’s compliance and subsequently increase measure’s rates.
• Calling provider offices to request / validate facility and provider addresses, and / or collect medical records for the HEDIS project.
• Data entry of change of addresses into system.
• Uploading records upon receipt.
• Documenting all outreach efforts.
• Working with MS Excel.
• Heavy chart monitoring and auditing of medical records.
• Monitor the production of quality results reporting; analyze, track and trend the reporting results and report them to management.
• Formulate and prepare ad-hoc and additional reporting requirements
• Recommend, develop, and implement quality improvement plans with management
• Train providers and staff in methodologies and tools of continuous quality improvement
• Prepare for and participate in meetings with State agencies, providers, and stakeholders
• Perform audits on to meet state and internal requirements
• Performs other duties as assigned.

Key Requirements and Technology Experience :

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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