HEDIS Coordinator (Remote Option-NC)

About the position The HEDIS Coordinator's primary role is to ensure compliance with HEDIS standards, support quality improvement initiatives, and facilitate communication between departments. They assist Quality Advisors by providing essential data and coordinating appointments related to quality improvement activities. Additionally, they engage with members to educate them about quality measures and encourage their participation in healthcare initiatives. Overall, the HEDIS Coordinator plays a crucial role in enhancing patient outcomes and organizational success through meticulous data management and effective communication.

Responsibilities

• Compliance Oversight Ensuring adherence to HEDIS standards by overseeing data collection, analysis, and reporting processes.
• Data Management Managing the collection, validation, and aggregation of data required for HEDIS reporting.
• Quality Improvement Support Collaborating with Quality Improvement teams and Quality Practice Advisors to identify opportunities for improvement based on HEDIS data analysis.
• Documentation and Coding Support Providing guidance to healthcare providers on proper documentation practices to accurately reflect patient care.
• Performance Monitoring Monitoring performance metrics related to HEDIS measures and identifying areas of concern or improvement.
• Training and Education Conducting training sessions or workshops to educate staff and providers on HEDIS measures.
• Interdepartmental Coordination Acting as a liaison between different departments involved in HEDIS reporting and quality improvement efforts.
• Audit Preparation Assisting in the preparation for HEDIS audits by ensuring all necessary documentation and data are accurate.
• Member Outreach Engaging with members to educate them about HEDIS measures and promote participation in healthcare programs.
• Continuous Improvement Continuously evaluating processes and procedures related to HEDIS reporting and quality improvement.

Requirements

• High School Diploma or equivalent.
• Minimum 3-5 years of experience in healthcare administration, medical records, or healthcare data management.
• Minimum 2 years of experience with healthcare quality measures or clinical data reporting.
• Experience with HEDIS measures, healthcare auditing, or quality improvement initiatives.
• Demonstrated experience working with healthcare providers and clinical documentation.
• Experience coordinating projects and managing multiple deadlines in healthcare setting.
• Knowledge of HEDIS coding requirements.
• Advanced proficiency in Microsoft Excel (pivot tables, VLOOKUP, data analysis functions).
• Experience with healthcare databases and electronic health record systems.
• Demonstrated ability to collect, validate, and analyze healthcare data. Nice-to-haves
• Associate or bachelor's degree in healthcare administration, Health Information Management, or related field.
• 7+ years of experience in managed care or health plan environment.
• Previous experience in HEDIS reporting and NCQA accreditation processes.
• Experience with SQL, SAS, R, or other data analysis software.
• Experience in Medicare Advantage and Medicaid managed care operations.
• Project Management Professional (PMP) certification.
• Six Sigma Green Belt or similar quality improvement certification.

Benefits

• Annual incentive bonus plan.
• Medical, dental, and vision insurance with low deductible/low cost health plan.
• Generous vacation and sick time accrual.
• 12 paid holidays.
• State Retirement (pension plan).
• 401(k) Plan with employer match.
• Company paid life and disability insurance.
• Wellness Programs.
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