Job Description:
Job Title: Quality Improvement Specialist (HEDIS)
Contract Duration: 6 Months
Pay Range: XXXXXXXXXXX - XXXXXXXXXXX per hour on w2.
Work Location: Remote
Work Schedule: Monday Friday, 8:00 AM 5:00 PM Central Time
Note: Typing test and Computer Literacy Test is required
Position Summary
- We are seeking Quality Improvement Specialists (HEDIS) to support quality improvement projects related to HEDIS Hybrid Operations. This role will provide clinical and administrative support for medical record research, review, abstraction, over-read, audit processes, and quality improvement initiatives.
- The primary objective is to support year-end HEDIS initiatives by completing year-round measures and specific projects required to close care gaps before the year-end cutoff. Following these initiatives, the contractors will transition to supporting the HEDIS Hybrid Project, which includes 12 projects involving medical record requests and reviews to improve Star Ratings across all health plan lines of business.
- The ideal candidates will have experience with HEDIS, NCQA technical specifications, gap closure, medical terminology, quality improvement, and medical record review. Strong analytical, documentation, communication, and Microsoft Office skills are essential for success in this role.
Key Responsibilities
- Support the development and maintenance of quality improvement projects related to HEDIS Hybrid Operations.
- Provide support to health plans in the clinical aspects of medical record review.
- Conduct medical record research, review, abstraction, and related documentation activities.
- Support medical record abstraction, over-read, and audit processes.
- Conduct medical record request and fax-based projects to support HEDIS gap closure.
- Train providers, health plans, and staff on continuous quality improvement methodologies and tools, including HEDIS abstraction and over-read processes.
- Monitor performance against established contractual quality indicators.
- Analyze, track, and trend quality improvement results.
- Prepare for and participate in meetings with committees, state agencies, providers, health plans, vendors, and other stakeholders.
- Recommend, develop, and implement Performance Improvement Plans (PIPs) with management using the Plan-Do-Study-Act (PDSA) model.
- Monitor and report PIP progress through completion and closure.
- Collaborate and communicate with team members daily to support project deliverables.
- Complete assigned year-round HEDIS measures and quality projects to close gaps before the year-end cutoff.
- Transition to supporting the HEDIS Hybrid Project, including medical record requests and reviews across 12 projects, to help improve Star Ratings across all health plan lines of business.
- Perform other duties as assigned.
- Comply with all applicable policies, procedures, and standards.
Project Overview and Business Need
- Workers are needed to support year-end initiatives for the HEDIS team. The initial focus will be on completing year-round measures and specific projects to close gaps before the year-end cutoff.
- After completing these activities, the contractors will transition to supporting the HEDIS Hybrid Project, which involves 12 projects focused on medical record requests and reviews. These efforts aim to improve Star Ratings across all health plan lines of business.
- The work will include medical record research, review, abstraction, fax projects, and daily collaboration with the team.
Required Qualifications
- Bachelor's degree in Nursing, Healthcare, or Quality, including HEDIS measures or NCQA, or equivalent experience in a related healthcare field.
- Experience with NCQA and HEDIS gap closure.
- Knowledge of NCQA technical specifications and the ability to navigate and apply them.
- Strong medical terminology knowledge.
- Technical proficiency with Microsoft Excel, Word, and the Microsoft Office suite.
- Understanding of quality improvement, medical coding, data analytics, and compliance.
- Strong attention to detail and ability to review and maintain accurate medical records and documentation.
- Ability to analyze information, track results, and support quality improvement initiatives.
Preferred Qualifications
- Experience with HEDIS, NCQA, or related quality improvement activities.
- Valid state clinical license, such as RN or LPN, preferred but not required.
- Experience with medical record abstraction, over-read, and audit processes.
- Experience with quality performance improvement plans and the PDSA model.
- Experience in medical coding, data analytics, and healthcare compliance.
Top Three Must-Have Skills
- NCQA Technical Specifications: Knowledge of NCQA technical specifications and the ability to navigate and utilize them effectively.
- Medical Terminology: Strong understanding of medical terminology and healthcare documentation.
- Technical Skills: Proficiency in Microsoft Excel, Word, and the Microsoft Office suite.
Additional Qualities to Look For
- Quality improvement experience.
- Medical coding knowledge.
- Data analytics skills.
- Understanding of healthcare compliance.
- Strong organizational and documentation skills.
- Ability to collaborate with team members and stakeholders.