HEDIS Coordinator

Summary:

• Work Mode: Remote – Nationally sourced
• Schedule: 8:00-5:00 PM CST Monday-Friday – OT as needed based on project needs
• Duration: 3.5 months only

Responsibilities:

• Ensure HEDIS data accuracy and reporting, including investigation, auditing, and improvement opportunities.
• Assist with quality improvement initiatives in the service and clinical areas.
• 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 processes 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 audits and maintain all data and process controls to ensure compliance.
• Monitor/manage incoming medical records; including downloading, splitting, and renaming of incoming records via fax or email.
• Investigate and contact providers to confirm demographic information and request medical records.
• Escalate chart retrieval efforts as needed to ensure record retrieval.
• Manage pended ‘unable to contact’ records.
• Review claims database for evidence of date of service.
• Potential for rate max of medical records for compliance with HEDIS standards (depending on experience).
• Comply with all policies and standards.
• Perform other duties as assigned.

Requirements:

• Bachelor’s degree in a related field or equivalent experience.
• Minimum 3 years of quality improvement or healthcare-related experience.
• Working knowledge of the National Committee on Quality Assurance (NCQA).
• HEDIS requirements preferred.
• Medical Record Experience.
• Health care or MCO experience.
• Strong computer program and navigational skills (Excel, Outlook, Adobe PDF, etc.).

Preferred Skills:

• Claims Experience.
• Datavant portal experience.
• Provider outreach call experience.
• HEDIS or NCQA knowledge.