HEDIS Quality & Data Compliance Specialist

Siho Insurance Group; Indianapolis, Northern (IN, KY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Siho Insurance Group seeks a Clinical Quality Specialist to support HEDIS data collection, submission, and auditing under the Director of Medical Management. You will collaborate with the Clinical Quality Nurse and data analyst to ensure accurate data for health partners and providers, supporting education efforts for HEDIS measures.

Responsibilities include coordinating submissions, maintaining guidelines, and assisting with audits for Medicare Advantage and commercial lines.

Qualifications

• HEDIS data collection experience preferred.
• Experience with clinical documentation review preferred.
• Proficiency in Microsoft Office Suite required or preferred.

Responsibilities

• Oversee HEDIS quality collection, submission, reporting, and auditing.
• Collaborate with Clinical Quality Nurse and data analyst on HEDIS data distribution.
• Communicate with health partners about submissions and education on measures.
• Assist with maintaining HEDIS guidelines, policies, and auditing documents.
• Support internal Chronic Care Improvement Program initiatives.

Skills

HEDIS data collection

Clinical documentation review

MS Office Suite

EMR systems

Professional communication

HEDIS certifications

Education

CMA or equivalent credential

Job description

Siho Insurance Group seeks a Clinical Quality Specialist to support HEDIS data collection, submission, and auditing under the Director of Medical Management. You will collaborate with the Clinical Quality Nurse and data analyst to ensure accurate data for health partners and providers, supporting education efforts for HEDIS measures.

Responsibilities include coordinating submissions, maintaining guidelines, and assisting with audits for Medicare Advantage and commercial lines.