HEDIS Coordinator

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Maintains the utmost level of confidentiality at all times.
• Adheres to Health System and Health Plan policies and procedures.
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Demonstrates a high degree of independence, flexibility, initiative, and commitment.
• Leads and collaborates in the project management of complex clinical data acquisition and implementation activities.
• This includes coordination with internal and external stakeholders, preparedness for annual HEDIS® reporting, including HEDIS® Electronic Clinical Data Systems (ECDS) measures, and providing ongoing support to sustain the optimal results of the project.
• PARTNERS WITH INTERNAL AND EXTERNAL STAKEHOLDERS TO ENSURE THAT DHP IS COMPLIANT WITH REGULATORY, ACCREDITATION, AND CONTRACTUAL REQUIREMENTS FOR HEDIS® AUDIT AND OTHER QUALITY ACTIVITIES TO MAXIMIZE ADMINISTRATIVE DATA CAPTURE AND LEVERAGE EFFICIENCIES TO MINIMIZE PROVIDER ADMINISTRATIVE BURDEN.
• Develop training materials, tools and educational resources to improve stakeholder understanding and knowledge of supplemental data sources, ECDS reporting, ECDS measures and methodology, and new technologies to maximize data capture.
• Collaborates with internal and external stakeholders to disseminate initiatives and audit results, including providers/practice groups, and committees.
• APPLIES ANALYTICS FROM THE PROVIDER PERFORMANCE PLATFORM AND OTHER INTERNAL SOURCES TO IDENTIFY/TARGET SPECIFIC POPULATIONS/PRACTICE GROUPS TO MAXIMIZE QUALITY INTERVENTIONS TO OPTIMIZE ADMINISTRATIVELY CAPTURED PERFORMANCE DATA.
• COORDINATES WITH THE DATA ANALYTICS AND DATA INTEGRATION TEAMS TO GATHER AND VALIDATE DATA NEEDED FOR MODELING AND ANALYSIS TO SUPPORT DEPARTMENTAL AND ORGANIZATIONAL QUALITY STRATEGIES AND NEEDS.
• Maintains knowledge of industry trends and standards including but not limited to National Committee on Quality Assurance (NCQA) and HEDIS® Technical specifications.

EDUCATION AND/OR EXPERIENCE

• Bachelor’s degree in health administration, Business Administration, Information Systems, Health Care, or health-related field required.
• Proficient knowledge of Microsoft Office products, including Word, Excel, Outlook, and PowerPoint.
• Preferred: Master’s degree in a health-related field preferred.
• Knowledge of National Committee on Quality Assurance (NCQA) specifications for HEDIS® audits, the managed care environment, and the basic tenets of quality improvement are strongly preferred.
• Two years of HEDIS® audit processes, including familiarity with supplemental clinical data, Electronic Clinical Data Systems (ECDS) reporting methodology, and experience with validating HEDIS® data sources preferred.
• Experience with Medicaid or Medicare benefit programs preferred.