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HEDIS Coordinator

Columbus, OH · Healthcare
HEDIS® Coordinator – Health Plan
Columbus, OH
  
*** Full Time, Benefits Available, CONTRACT opportunity, expected to last several months or longer! **
** Open to Non-Clinical professionals or LPN Nurses and Social Workers with correct experience!  **

HEDIS Coordinator Job Summary:  
  • 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 Coordinator Background:   
 
  • 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.
 ® “HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).”

#ADMIN
 
KAYLA ROGERS
STRATEGIC DIRECTOR, NON-CLINICAL DIVISION

CareNational
kayla@carenational.com
623.201.8732 (CALL – TEXT – FAX)
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