Job Profile Summary
Position Purpose:
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.
Education/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 Silver Summit Health Plan only: Driver's license required.
For Health Net Federal Services only: Government Security/Clearance/US Citizenship Requirements
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
Conduct quality audit and maintain all data and process controls to ensure compliance
Performs other duties as assigned
Complies with all policies and standards
EEO:
Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.
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| Story Behind the Need |
- What is the purpose of this team?
- What is driving this need? (ex. Backfill for FTE or CW, new project, business growth)
- Describe the surrounding team (team culture, work environment, etc.) & key projects.
- Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
| - This team is responsible for working with network providers to retrieve medical records for HEDIS
- HEDIS Year Round and Hybrid medical record retrieval
- Team culture is very collaborative in working towards our shared goals
- NA, no additional hiring needs
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| Typical Day in the Role |
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
| - Travel on site to provider offices to retrieve medical records for HEDIS
- Performance expectations: 1. 100% adherence to HIPAA 2. Retrieved records meet HEDIS criteria, are within required timeframe are legible, and complete. 3. Accurate indexing and naming of records, 4. Timely escalation and resolution of provider barriers affecting retrieval, 5. Maintain professional relationships with office staff and providers
- This role offers a unique opportunity to combine healthcare quality expertise with direct provider engagement. Unlike traditional office-based positions, the Medical Record Retrieval Specialist works directly with provider offices to obtain critical medical records that support HEDIS reporting, quality improvement initiatives, and better health outcomes. The role requires a blend of relationship-building, problem-solving, travel, and technical knowledge of medical records, EHR systems, and HEDIS measures, making a tangible impact on both provider performance and member care.
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| Candidate Requirements |
| Education/Certification | Required: Bachelor s degree in related field or equivalent experience. | Preferred: |
| Licensure | Required: Driver's license required and own vehicle | Preferred: |
Years of experience required: 3+ years of quality improvement or healthcare related experience.
Disqualifiers: no prior HEDIS expeirence
Additional qualities to look for: Comfortable with travelling to provider offices |
- Top 3 must-have hard skills stack-ranked by importance
| 1 | HEDIS Measures and Quality Improvement Knowledge- Understanding of HEDIS measure requirements, medical record documentation standards, and quality gap closure opportunities.
- Ability to identify records and documentation needed to support measure compliance and improve quality outcomes.
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| 2 | Medical Record Retrieval and Documentation Management - Ability to locate, request, collect, organize, and securely transmit medical records from provider offices.
- Understanding of medical record components, dates of service, and documentation requirements needed to support quality measures.
- Experience working with EMRs, provider portals, fax systems, scanning, and document management tools.
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| 3 | HIPAA Compliance & Healthcare Regulations- Knowledge of HIPAA, PHI handling, and data privacy requirements.
- Ability to securely transport, store, scan, and transmit confidential patient information.
- Understanding of audit and compliance standards related to medical record collection and quality reporting.
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| Candidate Review & Selection |
- Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
| Projected Manager Candidate Review Date: | 1-2 days post shortlisting |
Type of Interviews:
| 1 Teams camera on |
| Required Testing or Assessment (by Vendor): | NA |
| Next Steps |
- Do you have any upcoming PTO?
| December 14-18, 2026 |
- Colleagues to cc/delegate
| Tawonna Ingram |