HEDIS Lead for MAPD Quality & Star Programs

Verda Healthcare Inc; Huntington Beach (CA); On-site; USD 70,000 - 85,000; Full time

Benefits offered by this job

401(k)

Paid time off (vacation, holiday, sick

Health insurance

Dental Insurance

Vision insurance

Life insurance

Job summary

Verda Healthcare, Inc. in Huntington Beach, CA is seeking a seasoned HEDIS Lead to plan, coordinate, and audit HEDIS initiatives across the organization.

The role interfaces with the Senior Manager, HEDIS & Quality Improvement, Stars Program Manager, and internal teams to drive HEDIS and CMS Star performance. The ideal candidate will have extensive HEDIS knowledge, NCQA experience, and hands-on medical record review/abstraction, supporting MAPD reporting and data quality initiatives.

Qualifications

• Bachelor’s degree or higher in a healthcare-related field.
• 3–5 years of healthcare quality experience within a health plan, IPA, MSO, or similar setting.
• 2–3 years of HEDIS experience, including medical record review and abstraction.
• Experience supporting MAPD HEDIS reporting programs.
• Knowledge of NCQA HEDIS requirements and audits.
• Experience working with delegated entities, providers, and vendors.

Responsibilities

• Support annual HEDIS project planning, implementation, and execution activities.
• Coordinate HEDIS data collection with internal teams, entities, and vendors.
• Perform medical record review and chart abstraction for HEDIS reporting.
• Interpret HEDIS specs and assist stakeholders with measure requirements.
• Monitor measure performance and identify improvement opportunities.
• Support provider outreach and education on HEDIS measures.
• Serve as backup lead for NCQA HEDIS Compliance Audits and assist with audit prep.
• Coordinate audit requests, universes, and evidence submission.
• Validate medical record documentation and data sources.
• Partner with vendors, auditors, and internal teams to ensure NCQA compliance.
• Maintain audit readiness for MAPD HEDIS reporting.
• Support Stars Program during medical record season and reporting.
• Collaborate on CMS Star Ratings initiatives and measure performance monitoring.
• Assist with provider education on Star measures and quality initiatives.
• Assist with Data Quality Management planning, validation, and issue resolution.
• Identify data quality issues and coordinate corrective actions.
• Participate in root-cause analysis and action planning.
• Develop and maintain reports, dashboards, and status updates.
• Present findings to leadership and stakeholders.
• Participate in cross-functional quality improvement meetings.
• Support departmental goals and special projects.

Skills

HEDIS knowledge

Healthcare quality

Data analysis

Project coordination

Vendor collaboration

Excel

Communication

Education

Bachelor’s degree in healthcare administration, Public Health, Nursing, Health Information Management, Business Administration, or related field

Tools

HEDIS software platforms

Medical record retrieval systems

Excel

Job description

Verda Healthcare, Inc. in Huntington Beach, CA is seeking a seasoned HEDIS Lead to plan, coordinate, and audit HEDIS initiatives across the organization.

The role interfaces with the Senior Manager, HEDIS & Quality Improvement, Stars Program Manager, and internal teams to drive HEDIS and CMS Star performance. The ideal candidate will have extensive HEDIS knowledge, NCQA experience, and hands-on medical record review/abstraction, supporting MAPD reporting and data quality initiatives.