Bilingual Quality & HEDIS Specialist

Suvida Healthcare LLC; Phoenix (AZ); On-site; USD 65,000 - 90,000; Full time

Job summary

Suvida Healthcare LLC in Phoenix, AZ seeks a Bilingual Quality Specialist to identify care gaps, perform chart audits, and manage HEDIS documentation. You will work with clinic staff and the Director of Quality to improve engagement, reporting accuracy, and overall care quality for Medicare-eligible Hispanic seniors.

The role includes educating staff on HEDIS specs, submitting payer documentation, and collaborating across departments.

Qualifications

• Bachelor's degree in healthcare administration or public health required.
• 4+ years of experience in value-based care setting (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.
• Must have a basic understanding of billing and claims coding.
• Experience reviewing Electronic Medical Records.
• Intermediate level experience in Microsoft Excel, Word, and PowerPoint.
• Experience navigating payer portals.
• At least 1 year of experience utilizing medical terminology.

Responsibilities

• Identify and notify clinical staff of next steps needed 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 time-sensitive measures.
• Collaborate with other departments on quality projects to reach goals.
• Act as a team player to promote positive health outcomes.
• Work Monday–Friday from 8–5 PM in the Arizona area; 10% travel within Arizona.

Skills

Quality Assurance

HEDIS

CMS Stars

Billing Knowledge

Payer Portals

EMR Review

Excel

Word

PowerPoint

Education

Bachelor's degree in healthcare administration or public health

Tools

Excel

Payer Portals

EMR/EHR Systems

MS Word

PowerPoint

Job description

Suvida Healthcare LLC in Phoenix, AZ seeks a Bilingual Quality Specialist to identify care gaps, perform chart audits, and manage HEDIS documentation. You will work with clinic staff and the Director of Quality to improve engagement, reporting accuracy, and overall care quality for Medicare-eligible Hispanic seniors.

The role includes educating staff on HEDIS specs, submitting payer documentation, and collaborating across departments.