HEDIS Coordinator

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Summary:

The HEDIS Coordinator will have customer service skills while measuring the performance of medical care and service. The HEDIS Coordinator will work hand in hand with insurance companies, providers, and other office staff to provide information they need for reliable comparison of health plan performance. The HEDIS Coordinator is responsible for closing HEDIS gaps, meeting daily goals for outreach, and uploading information to insurance portals.

ESSENTIAL JOB FUNCTIONS

Request and evaluate reports for member compliance for each HEDIS measure Performs medical record reviews, abstraction and data entry for HEDIS measures Reviews assigned medical records in order to abstract clinical data elements for HEDIS reporting, (e.g. results of laboratory tests, verification of hypertension and the most recent blood pressure reading, prenatal and postpartum care services, etc.) Conduct direct member outreach as needed Provide non-compliant member lists to office staff to close HEDIS measures Maintain appropriate patient documentation on the electronic medical record system Assist patients, office staff, and providers with quality measures Assist with implementation of Quality Improvement initiatives to improve HEDIS rates Integrates data collected from a variety of electronic and paper sources Organize and maintain a plan of action to improve HEDIS scores Develop and maintain member incentive programs to support HEDIS initiatives, and understand contract requirements Prepare and present HEDIS compliance reports for providers and quality team Perform audits for compliance with HEDIS measures Identifies when to refer patients to manager or medical staff Distribute educational information to members and providers in accordance with the HEDIS outreach work plan (mailings, automated calls, etc.) Maintain incentive database to track member compliance Complete projects/tasks in a timely manner Perform other duties as assigned

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES

Attention to detail Sense of urgency Ability to work in a fast-paced environment with deadlines Assertive and confident communication skills Problem-solving skills Computer skills Ability to handle confidential data Excel skills Juggle multiple tasks, remaining conscious of multiple deadlines Utilize advanced problem-solving skills to resolve issues and conflicts that may arise

LICENSE/EXPERIENCE/QUALIFICATIONS

Associate degree preferred Working knowledge of HEDIS preferred Working knowledge of billing codes preferred Experience in medical record review

PHYSICAL REQUIREMENTS

Ability to endure short, intermittent, and/or long periods of sitting and/or standing in performance of job duties Transport him/herself to other departments, conference rooms, and on occasion, to off-site locations to accomplish job responsibilities, attend meetings, workshops, seminars, etc. Join us at FoundCare, in sunny south Florida, where we offer an excellent compensation package including: Competitive base salary Full Suite of benefits including•Health Dental Vision Generous Paid Time Off Company-Paid Holidays Employer match retirement plan Great work environment•we have the BEST employees

Employment Schedule:

Employees work a 40 hours per week schedule: Monday through Thursday 8AM•8PM, Friday 8AM-5PM, and Saturday 8AM-1PM