Hedis/ Stars Coordinator II

Evolving Solution Services; Pasadena (CA); On-site; USD 100,289,000 - 108,886,000; Full time

Job summary

Evolving Solution Services in Pasadena, CA seeks a focused Coordinator to oversee HEDIS and CMS Stars activities under the Quality Improvement department. Under supervision, you will coordinate data collection, validation, and submission, ensuring timely, compliant performance reporting.

You will collaborate with provider offices, IT, and QA teams to analyze data, maintain documentation, support training, and drive process improvements that enhance healthcare quality and outcomes.

Qualifications

• High school graduate or GED equivalent.
• 2-3 years’ experience supporting HEDIS®, AMP, or other performance program preferred.
• Or at least 3 years’ experience working in an IPA/MSO/Health plan or healthcare quality environment.

Responsibilities

• Coordinate HEDIS® data collection, validation, and submission per NCQA timelines.
• Ensure data accuracy through regular reviews of Cozeva/EDI reconciliation reports.
• Maintain documentation of data collection methodologies and results.
• Collaborate with providers, IT, and QA teams to improve data capture and reporting.
• Analyze HEDIS® data to identify trends and provide insights to partners.
• Assist in training materials for stakeholders on HEDIS® measures and compliance.

Skills

Attention to detail

Regulatory knowledge

Communication skills

Time management

Collaboration

Education

High school diploma or GED

Tools

Cozeva platform

EMR systems

Microsoft Word

Microsoft Excel

PowerPoint

Outlook

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time Pasadena, CA, US

Salary Range: $35.00 To $38.00 Hourly

JOB DESCRIPTION

DEPARTMENT: Quality Improvement

REPORTS TO: Quality Programs Manager, Imperial Health Plan

JOB SUMMARY: Under direct supervision of QI Leadership, responsible for coordinating NCQA Healthcare Effectiveness Data and Information Set (HEDIS®) and CMS Stars activities, ensuring compliance with regulatory requirements and quality standards. This role requires effective communication and the ability to manage competing priorities and work collaboratively with various departments and external provider offices.

ESSENTIAL JOB FUNCTIONS:

• HEDIS® Data Collection: Coordinate the collection, validation, and submission of HEDIS® data in accordance with NCQA guidelines and timelines.
• Quality Assurance: Ensure the accuracy and completeness of HEDIS® data by performing regular reviews of Cozeva / EDI reconciliation reports.
• Compliance: Stay up to date with HEDIS® and Stars specifications and regulatory requirements, ensuring all processes and submissions comply with standards.
• Documentation: Maintain detailed and accurate records of HEDIS® activities, including data collection methodologies, validation processes, and results. Ensure documented findings are reflected appropriately in the annual HEDIS® ROADMAP.
• Data Analysis Support: Review HEDIS® data reports from Cozeva to identify trends and gaps to provide actionable insights to provider partners in the interest of improving healthcare quality and performance.
• Reporting: Work with internal departments to prepare and maintain HEDIS® reports to management and external stakeholders and provider partners, highlighting key findings.
• Training and Support: Help maintain and update training materials for internal and external stakeholders on HEDIS® measures, data collection procedures, and compliance requirements.
• Process Improvement: Continuously evaluate and enhance documentation and inter-departmental coordination processes to improve efficiency, accuracy, and outcomes.
• Collaboration: Work closely with healthcare providers, quality improvement teams, IT, and other departments to ensure seamless HEDIS® data collection and reporting.
• Coordination: Ensure that meetings associated with HEDIS®/Stars activities and timelines, per applicable internal and external P&Ps and regulations, are timely and that invited parties have access to necessary information/documents to facilitate focused discussion. Also coordinates member and provider communications as appropriate when requested.
• Adheres to payroll policies and properly uses a time-keeping system with minimal manual changes.
• Maintains regular and consistent attendance.
• Assists management with other duties as assigned.
• Adheres to Compliance Plan and HIPAA regulations.

MARGINAL JOB FUNCTIONS:

• Takes on related special projects as needed.
• Supports other teams when needed to meet associated QI goals.

BEHAVIORAL EXPECTATIONS:

a. Attends staff meetings as required.

b. Attends appropriate training, seminars and workshops as required

2. Customer Focus:

a. Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations

and IMAS’s Standards of Conduct.

b. Fosters appropriate communication and relations with Manager, Supervisor, co-workers, and other staff.

3. Quality/Process Improvement/Safety

a. Reports issues of security, health and/or safety to appropriate manager as soon as practicable.

b. Supports and demonstrates safety throughout all duties performed.

c. Follows established policies and procedures and understands and complies with all regulators

standards set forth by governing entities.

POSITION REQUIREMENTS:

EDUCATION/EXPERIENCE:

• High school graduate or GED equivalent
• 2-3 years’ experience supporting HEDIS®, AMP, or other performance program preferred
• orat least3 years’ experience working in an IPA/MSO/Health plan or general healthcare quality environment

SKILLS/KNOWLEDGE/ABILITY:

• Microsoft Word, Outlook, Excel, and PowerPoint
• Good organization and time management skills
• Abilityto effectively prioritize items/tasks in a busy department environment
• Knowledge of the Cozeva platform a plus
• Effective verbal and written communication skills
• Willingness and ability to follow directions and perform work independently according to department standards
• Ability to navigate various Electronic Medical Records (EMR) systems a plus