HEDIS & Care Quality Specialist

Borinquen Health Care Center, Inc; Miami (FL); On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Medical/Dental/Vision Insurance

Job summary

Borinquen Medical Centers in Miami, FL is seeking a full-time HEDIS Specialist to join our Care team. You will communicate provider participation information to internal and external customers to support patient scheduling and reimbursement while meeting HEDIS & P4P measures.

Responsibilities include updating patient registration data, coordinating with departments, supporting QI and policy processes, and documenting in the E.H.R. to ensure continuity of care.

Qualifications

• Bachelor’s degree required.
• Minimum 1 year of customer service.
• Bilingual Spanish and/or Creole preferred.
• Ability to handle confidential information.

Responsibilities

• Coordinate and complete HEDIS quality projects aligned with BHCC goals.
• Obtain patient rosters from participating health plans.
• Call registered patients to set appointments and evaluate Quality Management.
• Validate rosters, schedule appointments, and ensure compliance with quality measures.
• Track quality measures and communicate care needs to patients and plans.
• Assist with chronic care management and care gaps.
• Audit records for HEDIS/NCQA standards and ensure access to care.

Skills

Bilingual Spanish/Creole

Microsoft Office

Interpersonal skills

Education

Bachelor’s Degree

Job description

Borinquen Medical Centers in Miami, FL is seeking a full-time HEDIS Specialist to join our Care team. You will communicate provider participation information to internal and external customers to support patient scheduling and reimbursement while meeting HEDIS & P4P measures.

Responsibilities include updating patient registration data, coordinating with departments, supporting QI and policy processes, and documenting in the E.H.R. to ensure continuity of care.