HEDIS Coordinator (Remote Option-NC)

Santa Barbara Cottage Hospital; United States; Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Annual incentive bonus

Medical, dental, and vision insurance

Generous vacation and sick time

12 paid holidays

State Retirement (pension)

401(k) plan with employer match

Life and disability insurance

Wellness programs

Public Service Loan Forgiveness Qualif

Job summary

Santa Barbara Cottage Hospital is seeking a detail-oriented HEDIS Coordinator to ensure compliance with HEDIS standards, support quality initiatives, and coordinate data reporting across departments. The role emphasizes data accuracy and effective communication with Quality Advisors.

The position requires experience in healthcare data management and familiarity with coding guidelines, ICD-10, and CPT, along with strong Excel skills.

Qualifications

• Minimum 3–5 years of healthcare administration, medical records, or data management.
• Experience with HEDIS measures, healthcare auditing, or quality improvement initiatives.
• Knowledge of ICD-10, CPT coding and related guidelines.
• Ability to interpret healthcare reports and identify data discrepancies.

Responsibilities

• Compliance Oversight: Ensuring adherence to HEDIS standards by overseeing data collection, analysis, and reporting processes.
• Data Management: Managing collection, validation, and aggregation of data for HEDIS and state reporting.
• Quality Improvement Support: Identifying opportunities for improvement based on HEDIS data and assisting in implementing initiatives.
• Documentation and Coding Guidance: Providing guidance on proper documentation practices and coding guidelines for HEDIS measures.
• Audit Preparation: Assisting in PMV and HEDIS audit preparations and addressing findings.
• Training and Education: Conducting training sessions to educate staff on HEDIS measures and data collection.
• Interdepartmental Coordination: Coordinating with departments for accurate reporting.
• Continuous Improvement: Evaluating processes to streamline HEDIS reporting and data accuracy.

Skills

Analytical

Communication

Organizational

Attention to detail

Problem solving

Education

High School Diploma or equivalent

Associate or bachelor’s degree in healthcare administration or related field

Tools

Microsoft Excel

EHR systems

SQL/SAS/R

Job description

Competitive Compensation & Benefits Package!

Position eligible for –

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs
• Public Service Loan Forgiveness Qualifying Employer

See attachment for additional details.

Office Location:

Remote/hybrid Option; Available for any of Partners' NC locations (or within 40 miles of NC border)

Closing Date:

Open Until Filled

Primary Purpose of Position:

The HEDIS Coordinator's primary role is to ensure compliance with HEDIS standards, support quality improvement initiatives, and facilitate communication between departments. They assist Quality Advisors by providing essential data and coordinating appointments related to quality improvement activities. Overall, the HEDIS Coordinator plays a crucial role in enhancing patient outcomes and organizational success through meticulous data management and effective communication.

Role and Responsibilities:

• Compliance Oversight: Ensuring adherence to HEDIS standards by overseeing data collection, analysis, and reporting processes. This involves staying updated on HEDIS measures, guidelines, and regulatory requirements
• Data Management: Managing the collection, validation, and aggregation of data required for HEDIS and state reporting. This includes coordinating with internal departments and external stakeholders to gather necessary information.
• Quality Improvement Support: Collaborating with Quality Improvement teams to identify opportunities for improvement based on HEDIS data analysis. Assisting in the development and implementation of quality improvement initiatives.
• Documentation and Coding Support: Providing guidance to healthcare providers on proper documentation practices to accurately reflect patient care and meet HEDIS requirements. Assisting in the interpretation and application of coding guidelines related to HEDIS measures.
• Performance Monitoring: Monitoring performance metrics related to HEDIS measures and identifying areas of concern or improvement. Tracking progress towards goals and reporting findings to relevant stakeholders.
• Training and Education: Conducting training sessions or workshops to educate staff and providers on HEDIS measures, data collection methods, and documentation requirements. Providing ongoing support and guidance as needed.
• Interdepartmental Coordination: Acting as a liaison between different departments within the organization involved in HEDIS reporting and quality improvement efforts. Facilitating communication and collaboration to ensure alignment of goals and strategies.
• Audit Preparation: Assisting in the preparation for the annual PMV and HEDIS audits by ensuring all necessary documentation and data are accurate, complete, and readily accessible. Participating in audit processes and addressing any findings or recommendations.
• Continuous Improvement: Continuously evaluating processes and procedures related to HEDIS reporting and quality improvement. Identifying opportunities for streamlining operations, enhancing efficiency, and improving data accuracy.

Overall, the HEDIS Coordinator plays a critical role in ensuring the organization's compliance with HEDIS standards, driving quality improvement initiatives, and ultimately improving the quality of care delivered to patients. Their responsibilities span across data management, quality assurance, education, communication, and process improvement.

Knowledge, Skills and Abilities:

Knowledge:

• 1. In-depth understanding of Healthcare Effectiveness Data and Information Set (HEDIS) measures, including specifications, guidelines, and reporting requirements.
• 2. Knowledge of healthcare quality improvement principles, methodologies, and best practices.
• 3. Familiarity with medical coding systems (e.g., ICD-10, CPT) and healthcare documentation standards.
• 4. Understanding of regulatory requirements and compliance standards relevant to HEDIS reporting and quality improvement initiatives.
• 5. Knowledge of data collection, abstraction, and analysis techniques, including proficiency in data management tools and software used for HEDIS reporting.

Skills:

• 1. Analytical skills: Ability to interpret complex data sets, identify trends, and draw meaningful conclusions to support quality improvement efforts.
• 2. Communication skills: Excellent verbal and written communication skills to effectively convey technical information, collaborate with stakeholders, and facilitate training sessions.
• 3. Organizational skills: Strong organizational and project management skills to coordinate HEDIS data collection, reporting, and quality improvement activities within established timelines.
• 4. Attention to detail: Meticulous attention to detail and accuracy in data collection, documentation, and reporting to ensure compliance with HEDIS standards.
• 5. Problem-solving skills: Ability to proactively identify issues, develop solutions, and implement corrective actions to address challenges encountered during the HEDIS reporting process.

Abilities:

• 1. Collaboration: Ability to work collaboratively with cross-functional teams, healthcare providers, and external stakeholders to facilitate HEDIS data collection and quality improvement initiatives.
• 2. Adaptability: Flexibility to adapt to changing priorities, organizational dynamics, and evolving regulatory requirements related to HEDIS reporting.
• 3. Time management: Strong time management skills to effectively prioritize tasks, manage competing priorities, and meet deadlines in a fast-paced healthcare environment.
• 4. Customer service orientation: Ability to provide support and guidance to healthcare providers and internal stakeholders, demonstrating a commitment to customer service and quality improvement.
• 5. Results-driven: Ability to drive results and achieve measurable outcomes in HEDIS reporting and quality improvement initiatives, including improving performance on HEDIS measures and closing care gaps.

Education Required:

• High School Diploma or equivalent

Experience Required:

• Minimum 3-5 years of experience in healthcare administration, medical records, or healthcare data management
• Minimum 2 years of experience with healthcare quality measures or clinical data reporting
• Experience with HEDIS measures, healthcare auditing, or quality improvement initiatives
• Demonstrated experience working with healthcare providers and clinical documentation
• Experience coordinating projects and managing multiple deadlines in healthcare setting
• Knowledge of HEDIS coding requirements

Technical Skills Required:

• Advanced proficiency in Microsoft Excel (pivot tables, VLOOKUP, data analysis functions)
• Experience with healthcare databases and electronic health record systems
• Demonstrated ability to collect, validate, and analyze healthcare data
• Experience with project management and coordination of cross-functional teams
• Ability to interpret healthcare reports and identify data discrepancies

Education/Experience Preferred:

• Associate or bachelor’s degree in healthcare administration, Health Information Management, or related field
• 7+ years of experience in managed care or health plan environment
• 2-3 years of previous experience in HEDIS reporting and NCQA accreditation processes
• Prior experience working within a certified HEDIS Engine
• Experience with SQL, SAS, R, or other data analysis software
• Experience in Medicare Advantage and Medicaid managed care operations
• Project Management Professional (PMP) certification
• Six Sigma Green Belt or similar quality improvement certification