Description
Baptist Health is looking for a HEDIS Specialist I to join our team. This is a remote position that requires residency in KY, IN, IL.
Under direction from the Director of Clinical Outcomes for Value Based Care and with guidance from the HEDIS Specialist II, the Healthcare Effectiveness Data and Information Set (HEDIS) Specialist I is responsible for implementation and completion of payer audits;
and collaborates with HEDIS Specialist II on education for Clinical Integration Network and Accountable Care Organization members and their support staff regarding CIN, payer partnerships, HEDIS program measures and ACO program measure specifications.
Subject matter expert on various measure sources including but not limited to CMS and NCQA HEDIS as well as payer-specific measures regarding Utilization and Cost Effectiveness.
Researches and maintains database of abnormal results on audits for care management / system outreach and shares that information with the HEDIS Specialist II for analysis.
Assists with organizing and presenting accurate reports to instill confidence in Value Based programs.Maintains a positive working relationship and ongoing communication with CIN, payer partnerships and ACO staff, physicians and their support staff, hospital staff members, physician leadership and hospital leadership.
Assists with ACO and payer audit annually and works closely with ACO, payers and Baptist Health System staff seamlessly.
Proactively identifies and reports any special needs and potential problems to leadership to ensure the programs’ success.
Demonstrates necessary interpersonal skills and maintains a positive and professional atmosphere in the department.Follows system and Departmental Policies and Procedures.
Requirements
LPN licensure in the state of KY and at least 3 years of clinical experience.
Experience with education and care management preferred.
Experience with quality outcomes required.
Baptist Health is an employer.
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