HEDIS Coordinator

Spectraforce Technologies, Inc.; Raleigh (NC); Remote; USD 65,000 - 90,000; Full time

Job summary

Spectraforce Technologies, Inc. is seeking a remote HEDIS Coordinator to ensure data accuracy and lead quality improvement initiatives. You will audit records, investigate discrepancies, and drive opportunities across Medicaid and Marketplace populations.

The role requires 3+ years in quality improvement or HEDIS, with strong EMR and Excel skills. Remote work, Q4 focus, and cross-functional collaboration are key elements of this contract.

Qualifications

• 3+ years in Quality Improvement/HEDIS
• Bachelor's Degree preferred
• Knowledge of NCQA and HEDIS requirements preferred

Responsibilities

• Coordinate, complete, and update management on clinical quality metrics and HEDIS processes and results
• Establish and maintain an action plan to improve HEDIS scores
• Implement process to request and evaluate member compliance reports for each HEDIS measure
• Collaborate with providers and internal departments on rate investigation and validation activities
• Manage the HEDIS project including nurse assignments and vendor oversight
• Conduct quality audits and maintain data/process controls for compliance
• Performs other duties as assigned
• Complies with all policies and standards

Skills

HEDIS experience

EMR experience

Team collaboration

Education

Bachelor's degree

Tools

Microsoft Excel

Microsoft Office

Job description

Position Title: HEDIS Coordinator

Work Location: Remote, no specific state or time zone

Assignment Duration: 2 months potential to extend

Work Schedule: 8 hour work day, no OT M-F 8-5 in their time zone

Work Arrangement: Remote

Position Summary:

Perform duties to ensure HEDIS data accuracy and reporting, including investigation, auditing, and improvement opportunities. Assist with quality improvement initiatives in the service and clinical areas.

Background & Context:

We are needing assistance in Q4 to bring in more records to close HEDIS care gaps and review submitted records. We have a strong team that is very knowledgeable in HEDIS, but are needing extra assistance to pull and process records for Medicaid and Marketplace populations.

Key Responsibilities:

• Coordinate, complete, and update management on clinical quality metrics and HEDIS processes and results
• Establish and maintain an action plan to improve HEDIS scores
• Implement process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities
• Collaborate with providers and internal departments on rate investigation and validation activities, including maintaining all evidences, documentations, and changes
• Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality
• Conduct quality audit and maintain all data and process controls to ensure compliance
• Performs other duties as assigned
• Complies with all policies and standards

Qualification & Experience:

Education/Certification: Required: 3+ years in Quality Improvement/HEDIS. Preferred: Bachelor's Degree.

Licensure: Required: NA. Preferred: (none).

Years of experience required: Bachelor's degree in related field or equivalent experience. 3+ years of quality improvement or healthcare related experience. Working knowledge of the National Committee on Quality Assurance (NCQA). HEDIS requirements preferred.

Disqualifiers: No knowledge or work history with HEDIS.

Additional qualities to look for: Strong HEDIS measure experience, EMR experience.

Top 3 must-have hard skills stack-ranked by importance:

• HEDIS and EMR experience
• Microsoft Application experience, Excel
• Team collaborator and driven focus on task