HEDIS Data & Compliance Technician

Community Health of South Florida, Inc.; Miami (FL); On-site; USD 24,000 - 33,000; Full time

Job summary

Community Health of South Florida, Inc. is seeking a Population Health Compliance Technician in Miami, FL. This hourly, full-time role focuses on HEDIS data collection, medical record review, and coding accuracy to support compliance initiatives within a HIPAA-compliant environment.

The technician will review, abstract, and audit medical records, ensuring proper code assignment and data integrity. Collaboration with care teams and ongoing education are expected.

Qualifications

• Graduate from a Standard High School or GED Equivalent.
• Graduate from an approved Medical Coding Program, Medical Assisting program preferred.
• Maintain current CPR certification from the American Heart Association.
• MA certification or coding certification desired.

Responsibilities

• Perform accurate and comprehensive reviews of medical records for HEDIS measures.
• Auditing high volumes of medical records to ensure correct and appropriate code assignment.
• Ability to multitask and troubleshoot problems independently.
• Ensuring accurate data entry for claim submission.
• Medical record review, data abstraction, and quality experience.
• Schedule appointments with health care provider including appointments to PCP for their health risk assessments, preventative visits and chronic care management.
• Participate in Performance Improvement Activities.
• Participate in appropriate continuing education in service training.
• Maintain current licensure and/or certificates.
• Ability to read and interpret medical documents.
• Ability to prioritize, multi-task, and achieve goals on time; work independently and to self-motivate.
• Strong data entry skills; capable of using a computer efficiently and effectively.
• Able to navigate and master practice management and EHR software programs.
• Treat clients, team members and the public with courtesy, respect and present a positive public image.
• High production environment and, candidates must adhere to measured productivity requirements.
• Ensuring adherence to NCQA HEDIS guidelines.
• Research medical history to determine the most appropriate and source of necessary documentation.
• Based on a strong knowledge of HEDIS criteria, identify the medical information that supports the specific HEDIS measure.
• Responsible for obtaining, organizing, and securing a large volume of medical records within a limited timeframe.
• Adhere to department Policies and Procedures in performing duties and assignments.
• Demonstrates the ability to work with a diverse population.
• Ability to post appropriate CPT Category II Performance Measure codes after chart review and audit.
• Reports to work on time and ready to work with minimal absenteeism.
• Adheres to Confidentiality Policies and Procedures / HIPAA Regulations.
• Well organized with the ability to maintain attention to detail.
• Ability to work independently and as a team member.
• Maintains productivity standard of reviewing 60 medical records daily.

Skills

Medical Terminology

Keyboard

Medicare/Medicaid knowledge

NCQA HEDIS requirements

ICD9/CPT Coding

Basic computer knowledge

Bilingual English/Spanish (preferred)

Education

High School Diploma or GED

Medical Coding Program

Medical Assisting program preferred

Tools

EHR software

Job description

Community Health of South Florida, Inc. is seeking a Population Health Compliance Technician in Miami, FL. This hourly, full-time role focuses on HEDIS data collection, medical record review, and coding accuracy to support compliance initiatives within a HIPAA-compliant environment.

The technician will review, abstract, and audit medical records, ensuring proper code assignment and data integrity. Collaboration with care teams and ongoing education are expected.