HEDIS Specialist

Description

Job Summary:

Under direct supervision of the Director of Quality and Population Health, the position assists in coordination of overall HEDIS (Healthcare Effectiveness Data and Information Set) activities. Responsible for providing operational/strategic support in planning, coordinating, and validating HEDIS.

Hybrid Requirement: This position will regularly travel to DAP Health Clinics in San Diego county. 

Supervisory Responsibilities: N/A

Essential Duties and Responsibilities:

• Meets the organization’s customer services standards, including interpersonal communication and professional conduct expectations.  
• Assists with various aspects of the HEDIS process.
• Perform medical chart reviews to look for gaps in care such as missing mammograms, colon cancer screenings, diabetic screenings, etc.
• Track open quality gaps.
• Coordinates with clinical staff to inform them of missing screenings and HEDIS gaps.
• Coordinates HEDIS processes and establishes a plan to improve scores.
• Implement a process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities.
• Conduct quality audits.
• Coordinating HEDIS activities for internal departments, external partners, and contracted vendors.
• Manages HEDIS reporting process across the organization.
• Maintain all data and process controls to ensure compliance.
• Maintains interdepartmental lines of communication. 
• Assists in setting up all performance improvement activities across the organization.
• Prepare HEDIS findings for CQI committee so that CQI can consider and enact clinical risk recommendations to address quality issues and mitigate further legal risk exposure.
• Provides weekly data reports to departmental leadership.
• Maintains departmental database(s) (education, certifications, and schedules).
• Takes and transcribes, prepares, copies, and distributes meeting minutes as required.
• Assists with special projects and interdepartmental needs when appropriate.
• Performs other duties as assigned.

Qualifications

Qualifications:

Minimum Qualifications (Education and Experience):

• Bachelor's degree in nursing from an accredited college or university preferred.
• HEDIS certification preferred.
• High School Diploma or GED Equivalent required.
• Minimum 2-3 years’ experience in quality-improvement or health care required.
• Minimum 2 years’ experience with data analysis
• Experience with NCQA Survey Requirements and HEDIS reporting.
• Knowledge of medical terminology and basic charting
• Strong understanding of office procedures and protocol with an emphasis on good organizational skills and attention to detail.
• Ability to effectively prioritize multiple tasks and deadlines.
• Excellent customer service skills.
• Good oral and written communication skills. 
• Proficiency with basic office equipment (calculator, computer, copier, fax).  
• Intermediate computer skills with an emphasis on MS Word, Excel, Access, PowerPoint, Outlook, and desktop publishing. 

Knowledge, Skills and Abilities:

• Computer competence, highly effective collaboration, written and verbal communications skills. 
• Attention to detail development and maintenance of regulatory paperwork.
• Excellent oral and written communication skills.
• Effective interpersonal skills.
• Ability to set priorities and meet timelines for performance expectations, while maintaining strong attention to detail.
• Ability to work independently with minimal supervision and demonstrate initiative.
• Must demonstrate sound judgment and decision-making.
• Computer proficiency, including programs such as MS Office, Word, Excel, email, and internet research, required.
• Must be ethical and possess the ability to remain impartial and objective.
• Must exemplify strong, positive leadership skills.
• Must possess the ability to educate and train compliance and clinical standards to staff members.
• Must be able to travel as needed.
• Ability to effectively elicit/provide information to and from appropriate individuals (including, but not limited to, supervisors, co-workers, patients) via strong communication skills.