HEDIS® Coordinator – Health Plan
*** Full Time, Benefits Available, CONTRACT opportunity, expected to last several months or longer! ***
HEDIS Coordinator Job Summary:
** Open to Non-Clinical professionals or LPN Nurses and Social Workers with correct experience! **
HEDIS Coordinator Background:
- 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
- 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
® “HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).”#ADMIN
- Requires an education level of at least a high school diploma or GED.
- Associates or bachelor’s degree in nursing or related healthcare field is preferred; additional years of experience will be considered in lieu of education.
- Certified Professional in Healthcare Quality (CPHQ) and/or Utilization Review Certification (CPHM/CPUR/CPUM) is preferred.
- Requires 1-2 years of recent experience in Quality Improvement or HEDIS abstraction/support at a health plan or other managed care organization (HMO/TPA/IPA/etc).
- Prefer advanced certifications is coding, such as CPC, CCS, COC, CIC etc
- Knowledgeable of the Health Plan Employer Data Information Set (H.E.D.I.S.), as well as standards and reporting requirements for Medicare, Medicaid, and applicable state plans.
- Computer skills to include Electronic Health Records (EHR), Microsoft Word, basic data entry, and the ability to learn new and complex computer system applications.