HEDIS & Quality Improvement Coordinator

FLORIDA DOCTORS GROUP CORP; Coral Gables (FL); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Bonus based on performance

Company parties

Dental insurance

Health insurance

Opportunity for advancement

Paid time off

Vision insurance

Job summary

Florida Doctors Group MSO is seeking a HEDIS & Quality Coordinator to support our provider network in meeting HEDIS, preventive care, and quality performance requirements. This role will work with providers, medical office staff, health plans, and the FDG internal team to identify and close care gaps, obtain and review medical records, track measures, and ensure timely documentation.

The ideal candidate should be highly organized, comfortable communicating directly with medical practices, and

Qualifications

Responsibilities

• Monitor and track HEDIS measures and open care gaps across assigned providers and health plans.
• Review health plan reports, dashboards, and member-level gap reports to identify opportunities for improvement.
• Contact provider offices regularly regarding outstanding HEDIS measures and members requiring follow-up.
• Coordinate with provider offices to obtain medical records, lab results, screening documentation, encounter information, and other supporting documentation.
• Review documentation to determine whether HEDIS requirements appear to have been satisfied and submit appropriate records to the applicable health plan or internal department.
• Maintain detailed tracking of open, pending, submitted, and completed care gaps.
• Assist provider offices with understanding HEDIS requirements and the documentation needed for specific measures.
• Educate providers and office staff on the importance of preventive screenings, chronic disease management, follow-up care, and accurate medical-record documentation.
• Coordinate outreach initiatives for members who are due or overdue for recommended services.
• Follow up with provider offices to confirm appointments, completed services, and outstanding documentation.
• Work with health plans to reconcile discrepancies between provider records and health plan HEDIS reports.
• Assist with medical-record retrieval and HEDIS chart review activities.
• Track provider performance and identify practices requiring additional education or intervention.
• Prepare internal reports summarizing care-gap closure rates, outstanding measures, provider performance, and follow-up activity.
• Participate in health plan HEDIS and quality meetings, webinars, and training sessions as required.
• Stay informed regarding annual changes to HEDIS measures, health plan quality initiatives, and applicable CMS quality programs.
• Work collaboratively with FDG's Provider Relations, Coding/Risk Adjustment, Credentialing, Contracting, and other departments when necessary.
• Document all provider outreach, follow-ups, submissions, and resolutions accurately and timely.
• Escalate providers or outstanding items requiring management intervention.
• Maintain confidentiality and comply with HIPAA and all applicable privacy requirements.

Job description

Florida Doctors Group MSO is seeking a HEDIS & Quality Coordinator to support our provider network in meeting HEDIS, preventive care, and quality performance requirements. This role will work with providers, medical office staff, health plans, and the FDG internal team to identify and close care gaps, obtain and review medical records, track measures, and ensure timely documentation.

The ideal candidate should be highly organized, comfortable communicating directly with medical practices, and