HEDIS/Stars Coordinator II

Imperial Health Plan of California, Inc.; Pasadena (CA); On-site; USD 55,000 - 75,000; Full time

Job summary

Imperial Health Plan of California, Inc. is seeking a HEDIS/Stars Coordinator II to coordinate NCQA HEDIS data and CMS Stars activities under QI leadership.

The role requires effective communication, prioritization, and collaboration across departments and external provider offices to ensure regulatory compliance and quality standards. Under supervision, you will manage data collection, validation, and reporting, maintain documentation including the ROADMAP, and assist with training materials

Qualifications

• HEDIS/AMP experience preferred or related performance program exposure.
• IPA/MSO/health plan or healthcare quality environment background desired.
• Experience coordinating data collection, validation and reporting processes.

Responsibilities

• Coordinate HEDIS data collection, validation and submission per NCQA timelines.
• Review data reports to identify trends and provide actionable insights to providers.
• Maintain records of HEDIS activities and update the annual ROADMAP.
• Prepare HEDIS reports for management, external partners and provider networks.
• Support training materials on HEDIS measures and data procedures.
• Collaborate with IT, QA teams and providers to ensure data quality.
• Adhere to HIPAA and Compliance Plan; coordinate meetings and communications.

Skills

HEDIS knowledge

Communication skills

Time management

Prioritization

Team collaboration

Education

High school diploma or GED

Tools

Cozeva

EMR systems

Microsoft Word

Excel

PowerPoint

Outlook

Job description

Job Description

JOB TITLE: HEDIS®/Stars Coordinator II FLSA STATUS: Non-Exempt

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

• Continuous Learning:
• Attends staff meetings as required.
• Attends appropriate training, seminars and workshops as required
• Customer Focus:
• Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations

and IMAS’s Standards of Conduct.

• Fosters appropriate communication and relations with Manager, Supervisor, co-workers, and other staff.
• Quality/Process Improvement/Safety
• Reports issues of security, health and/or safety to appropriate manager as soon as practicable.
• Supports and demonstrates safety throughout all duties performed.
• Follows established policies and procedures and understands and complies with all regulators

standards set forth by governing entities.

Education/Experience

• 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 general healthcare quality environment

Skills/Knowledge/Ability

• Microsoft Word, Outlook, Excel, and PowerPoint
• Good organization and time management skills
• Ability to 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

Licensure/Certificate/Training

• N/A