HEDIS Quality Improvement Coordinator - Hybrid

Summary

The HEDIS/Quality Improvement Coordinator performs a key role in ensuring healthcare providers excel in meeting Quality Measures consistent with the CMS Star Rating Program. This position is responsible for medical record reviews, audits, and performance tracking for several providers as assigned.   Works closely with each provider to educate and identify areas of improvement ensuring compliance with regulatory guidelines.  This position will require strong organization, communication skills, and feedback to achieve maximum CMS Star Ratings every year.  Assists with other clerical duties as required.   

Essential Duties and Responsibilities

• Engages physicians and office staff to facilitate discussions on medication adherence, prescription refills and other metrics relevant to HEDIS Part D, aiming to gather comprehensive patient data.
• Performs medical record reviews, abstraction and data-entry for HEDIS as part of HEDIS operations.  
• Prepares reports and presentations outlining progress findings, and recommendations for management or regulatory bodies.
• Conducts monthly reviews in a timely manner and in accordance with established guidelines.  Tracks compliance issues, trend data, prepares regular reporting to enhance performance related to HEDIS measures, and distributes to providers and internal teams.
• Stays informed about the HEDIS/STAR rating requirements and applicable annual updates.
• Prepares, submits, and bill findings to external stakeholders, ensuring adherence to reporting deadlines.
• Presents a summary of all tracking reports to identify areas of improvement monthly or upon request.
• Road travel required - 25% (Miami-Dade and Broward Counties)
• Performs other related duties as assigned.

Knowledge, Skills and Abilities

• Strong organizational skills with keen attention to detail
• Ability to handle time-sensitive information, manage priorities and workflow.
• Excellent verbal and written communication skills.
• Proven customer service skills and demonstrated ability to deal effectively with a diversity of individuals.
• Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm.
• Proficient in Microsoft 365: Word, Excel, PowerPoint, Outlook and Teams.  
• Proven ability to handle multiple projects and meet deadlines.

Minimum Education and Experience

• Some college, plus two years of related professional work experience, or equivalent combination of education and experience.
• Two years of related healthcare experience working with ICD 9/10 codes and EMR’s.
• Basic knowledge and understanding of HEDIS projects.
• Bilingual (English and Spanish) required.
• Proven ability to use MS Office and perform diverse clerical functions within a professional work environment.

Note: Nothing in this job specification restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Critical features of this job are described under various headings above. They may be subject to change at any time due to reasonable accommodation or other reasons. The above statements are strictly intended to describe the general nature and level of the work being performed. They are not intended to be construed as a complete list of all responsibilities, duties, and skills required of employees in this position.