Bilingual HEDIS & Quality Specialist

Fleet Glass Services, Inc.; Phoenix, Northern (AZ, KY); Hybrid; USD 75,000 - 110,000; Full time

Benefits offered by this job

Free mental health & life coaching

Holiday time off with pay

Paid community service day

Paid parental/family leave

Generous PTO

401k with company match

Job summary

Suvida Healthcare seeks a Quality Specialist to close care gaps, audit data, and educate staff on HEDIS specs. The role collaborates with the Director of Quality and clinic teams to improve CMS measures and patient outcomes.

Requirements include a healthcare admin or public health degree, 4+ years in value-based care, and 2+ years in HEDIS/risk adjustment. Responsibilities include payer submissions, chart reviews, and cross‑department projects.

Qualifications

• Bachelor's degree in healthcare administration or public health required.
• Certified Medical Assistant, Certified Nursing Assistant, or NCQA certification with 2+ years of value-based care experience preferred.
• 4+ years in value-based care (primary care or Medicare Advantage preferred).
• 2+ years of HEDIS or Risk Adjustment experience in supplemental data and chart reviews.
• Knowledge of CMS STARS program.
• Basic understanding of billing and claims coding.
• Experience reviewing Electronic Medical Records.
• Intermediate MS Excel, Word, and PowerPoint skills.
• Experience navigating payer portals.
• At least 1 year of experience using medical terminology.

Responsibilities

• Identify and notify clinical staff of next steps to address open quality gaps.
• Submit documentation to payer portal to close quality gaps.
• Audit supplemental data to ensure results are compliant for identified measures.
• Educate staff and providers on HEDIS technical specifications.
• Resolve clinical staff quality inquiries.
• Join daily huddles to inform clinical staff of patients with outstanding time-sensitive measures.
• Collaborate with other departments on quality projects to reach goals.
• Work Monday–Friday 8–5PM and be in the Arizona area.
• 10% travel within Arizona.

Skills

Independent work

Problem solving

Multitasking

Fast-paced environment

Education

Bachelor's degree in healthcare administration

Bachelor's degree in public health

Tools

Excel

Word

PowerPoint

Job description

Suvida Healthcare seeks a Quality Specialist to close care gaps, audit data, and educate staff on HEDIS specs. The role collaborates with the Director of Quality and clinic teams to improve CMS measures and patient outcomes.

Requirements include a healthcare admin or public health degree, 4+ years in value-based care, and 2+ years in HEDIS/risk adjustment. Responsibilities include payer submissions, chart reviews, and cross‑department projects.