HEDIS Quality & Care Coordinator - Bilingual Spanish/Creole

Borinquen Health Care Center, Inc; Miami (FL); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Medical/Dental/Vision/Short Term Disb.

Job summary

Borinquen Health Care Center, Inc is seeking a full-time HEDIS Specialist in Miami, FL. The role focuses on communicating provider participation information and coordinating patient scheduling and reimbursement to meet HEDIS and P4P measures.

You will verify and update patient registrations, work with multiple departments, and support QI, Policy & Procedures, and Care teams. Daily to monthly reporting will be required to monitor quality gaps and care access.

Qualifications

• Well organized and bilingual (Spanish and/or Creole).
• Computer literacy with proficiency in Microsoft Office, including Outlook, Word, and Excel.
• Ability to interact effectively with patients, administration, faculty, and staff.
• Handle information with high level of confidentiality.
• Considerable knowledge of standard concepts, practices, and procedures within a field.
• Relies on limited experience and judgment to make decisions, plan and accomplish goals.
• Minimum 1 year of customer service.
• Strong interpersonal skills.
• Bachelor’s Degree.
• Experience in clinical background setting (LPN, MA) with case management experience.

Responsibilities

• Coordinating and completing HEDIS quality-specific projects.
• Obtain patient roster from participating health insurance plans.
• Call patients that are registered to set an appointment; evaluate Quality Management Tab, Avahana & HEDIS.
• Validate roster; schedule appointments and ensure compliance with quality measures.
• Track quality measures and promote BHCC services as needed.
• Assist with Chronic Care management and group visits; close Care Gaps.
• Track hospital discharges and ensure continuity of care.
• Periodically audit records for HEDIS and NCQA compliance.
• Ensure patient schedules and data reflect accurate care gaps.
• Provide data reports to QI Manager.

Skills

Bilingual (Spanish/Creole)

Interpersonal skills

Confidentiality

Customer service

Case management knowledge

Education

Bachelor’s Degree

LPN/MA with case management experience

Tools

Microsoft Office Suite (Outlook, Word, Excel)

Job description

Borinquen Health Care Center, Inc is seeking a full-time HEDIS Specialist in Miami, FL. The role focuses on communicating provider participation information and coordinating patient scheduling and reimbursement to meet HEDIS and P4P measures.

You will verify and update patient registrations, work with multiple departments, and support QI, Policy & Procedures, and Care teams. Daily to monthly reporting will be required to monitor quality gaps and care access.