HEDIS & Care Gaps Specialist - Bilingual

Socket.dev; Miami (FL); On-site; USD 55,000 - 78,000; Full time

Benefits offered by this job

Medical/Dental/Vision

Company paid long term disability

Life insurance

401K Plan

Holidays

Vacation and Sick Time

Amazing Team & Atmosphere

Job summary

Borinquen Medical Centers in Miami, FL seeks a full-time HEDIS Specialist to support HEDIS and P4P measures, verify patient data, and ensure access to care. You will work with the Care team and QI Manager to drive quality improvement and documentation.

Responsibilities include coordinating HEDIS projects, obtaining rosters, scheduling appointments, and auditing adherence to NCQA standards while maintaining confidentiality and communicating findings effectively.

Qualifications

• Associates degree required; Bachelor's degree preferred.
• Bilingual in Spanish and/or Creole.
• Proficient in Microsoft Office (Outlook, Word, Excel).
• Minimum 1 year of customer service.
• Clinical background with case management experience.
• Ability to maintain confidentiality.

Responsibilities

• Coordinate and complete HEDIS quality projects.
• Obtain patient rosters from participating health plans.
• Call patients to set appointments; evaluate HEDIS.
• Validate rosters; schedule appointments; ensure quality measures.
• Track quality measures and address care gaps.
• Track Medicare population utilization and access to care.
• Assist with Chronic Care Management and care gaps.
• Audit records to confirm HEDIS/NCQA standards.
• Communicate data verbally and in writing; provide reports to QI Manager.
• Perform and track call campaigns for non-compliant patients.

Skills

Communication skills

Bilingual (Spanish/Creole)

Interpersonal skills

Confidentiality

Customer service

Organizational skills

Microsoft Office

Decision making

Education

Associate degree

Bachelor's degree

Tools

Microsoft Office Suite

Job description

Borinquen Medical Centers in Miami, FL seeks a full-time HEDIS Specialist to support HEDIS and P4P measures, verify patient data, and ensure access to care. You will work with the Care team and QI Manager to drive quality improvement and documentation.

Responsibilities include coordinating HEDIS projects, obtaining rosters, scheduling appointments, and auditing adherence to NCQA standards while maintaining confidentiality and communicating findings effectively.