Hedis Coordinator

Effective communication and interpersonal skills for working with members, providers, and internal teams. Provide administrative support, including generating correspondence, organizing mailings, coordinating schedules, and supporting training.

HEDIS Coordinator (Entry Level)


Job Summary

The HEDIS Coordinator supports medical record review, retrieval, provider outreach, and HEDIS submission activities. This role conducts provider and member outreach, supports care gap closure initiatives, maintains accurate records, and ensures timely completion of HEDIS-related assignments while meeting productivity and quality standards.

Responsibilities

• Request and retrieve medical records from primary care providers, specialists, and various electronic medical record platforms.
• Schedule onsite medical record retrieval visits as needed.
• Negotiate with providers to support the successful and timely retrieval of medical records.
• Manage and maintain HEDIS files and medical records.
• Enter HEDIS medical record pursuit information accurately and thoroughly.
• Develop knowledge of HEDIS hybrid measures and medical record requirements.
• Research member claims and encounters to identify accurate information for medical record retrieval.
• Review medical records and identify compliance elements.
• Create and maintain detailed logs of member and provider interactions.
• De-escalate challenging situations professionally.
• Provide project support for member outreach and HEDIS initiatives.
• Work independently in a fast-paced environment while managing competing priorities and frequent interruptions.
• Complete assignments within specified timelines.
• Collaborate effectively on team projects and special initiatives.
• Conduct outbound calls to members and providers to collect information and support care coordination when needed.
• Educate members about missing care gaps and encourage them to obtain needed services.
• Provide administrative support, including generating correspondence, organizing mailings, coordinating schedules, and supporting training.

Requirements

• High school diploma or equivalent.
• At least two years of experience in health insurance operations, HEDIS audit support, member outreach, or inbound call campaigns.
• Basic or proficient knowledge of job-related systems and procedures gained through education or work experience.
• Proficient computer navigation skills, including the ability to work across multiple screens and applications.
• Strong communication, interpersonal, organization, and customer service skills.
• Critical thinking skills and effective time management abilities.
• Ability to establish priorities and manage assignments efficiently.
• Ability to maintain accurate notes, records, and documentation.
• Knowledge of NCQA requirements, HEDIS audits, and HEDIS measures.
• Working knowledge of Microsoft Office applications.

Skill

• Medical record retrieval and review
• Provider and member outreach
• HEDIS compliance and quality improvement
• Data entry and documentation
• Claims and encounter research
• Care gap identification and closure
• Customer service and conflict de-escalation
• Time management and prioritization
• Computer navigation and Microsoft Office proficiency
• Independent work and team collaboration

Summary Qualification

• Entry-level HEDIS coordination experience with a strong understanding of medical record retrieval and quality initiatives.
• Experience supporting health insurance operations, HEDIS audits, member outreach, or related healthcare activities.
• Strong attention to detail with the ability to maintain accurate records and meet deadlines.
• Effective communication and interpersonal skills for working with members, providers, and internal teams.
• Ability to manage a high-volume workload, adapt to changing priorities, and work independently.

Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status.