What Does a HEDIS Coordinator Do?
HEDIS (Healthcare Effectiveness Data and Information Set) is a tool widely used by healthcare employers to measure the performance of different medical care and service. HEDIS coordinators play a crucial role in that process by reviewing and analyzing data and metrics to make sure quality is achieved and maintained.
HEDIS coordinators work in physician’s offices, or other health care and wellness facilities.
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National Average Salary
HEDIS coordinator salaries vary by experience, industry, organization size, and geography. To explore salary ranges by local market, please visit our sister site zengig.com.
The average U.S. salary for a HEDIS Coordinator is:
HEDIS Coordinator Job Descriptions
The HEDIS Coordinator position is critical to HEDIS/QRS and Accreditation survey success. This role would be attractive to clinicians who are innovative self-starters, with a desire to integrate data/reporting, clinical knowledge sharing, as well as critical and strategic thinking in support of quality programs and outcomes. Acts as a resource/support person for management and clinical staff to ensure HEDIS effectiveness & efficiency, assisting in minimizing potential errors during the HEDIS survey while making sure all HEDIS activities remain within timeframes and staff are appropriately trained and prepared to successfully manage HCSC’s annual HEDIS survey. Serves as the liaison between the enterprise and the plan. This role will play an integral part in ABC Company’s annual performance including health plan accreditation, STARS, as well as API outcomes.
This lead position is responsible for coordinating and supporting the annual HEDIS and QRS medical record submission process in collaboration with Enterprise Quality and Accreditation to NCQA. Serves as a Subject Matter Expert and is responsible for coordinating HEDIS and QRS activities for internal departments, external partners, and contracted vendors. Responsible for providing operational/strategic support in planning, coordinating, and validating HEDIS and QRS Hybrid medical record reviews and outcomes.
- Registered Nurse (RN) or Clinician with an unrestricted, active license in the state of operations
- Bachelor’s degree in a related field
- Knowledge of HEDIS Technical Specifications, guidelines, and HEDIS survey process
- Minimum of 2 years experience with data analysis
- Minimum of 2 years in a healthcare environment
- Experience with NCQA Survey Requirements and HEDIS reporting.
- Experience utilizing various software packages including Excel, Access, and Word
- QSHR expertise including case management, report queries, data analysis, and clinical assignments
Preferred job requirements
- Project Management Experience
- Ability to interpret Quality Compass and understand IDSS rates
- Skilled at managing multiple competing projects in a fast-paced environment with problem-solving abilities
- Health plan knowledge including LOB/products
- Exceptional communication and collaboration skills
- Will participate in and provide guidance and support for the development and maintenance of the HEDIS Medical Record Review platform(s) to support all plans
- Coordinate the ongoing Medical Record collection and archiving of documents that support the Medical Record Review Projects, regulatory audits, and accreditation standards
- Work collaboratively with the Manager, HEDIS to maintain the Department SharePoint site, drives, medical records, blogs, newsletters, and other program materials as deemed necessary
- Participate in and provide support for process improvement initiatives with the medical record review process across the enterprise
- Maintain provider outreach to support HEDIS and MRR projects to include but not limited to validation of fax numbers, provider office locations, HEDIS contact information, scheduling of onsite retrieval appointments; maintenance and follow-up for pull lists and investigation into further needed documentation
- File copy company invoices, print pull list from MRR tool, and save to plan drive
- Pull incoming medical records from the fax and copy queues and save them to the appropriate plan drive in the designated measurement folders
- Scan all incoming medical records received via mail or onsite visit to the appropriate plan drive in the designated measurement folders
- Performs and applies structured auditing abstraction criteria to medical records to determine compliance with NCQA HEDIS specification and data collection activities as designated by the health plan for the measures such as CIS, IMA, CBP, CCS, or other measures as deemed necessary
- Work on designated projects assigned and deemed as necessary
- Ability to analyze data including statistical analyses. Ability to analyze practices, identify trends, and make recommendations for improvement of practice and processes related to Medical Record Retrieval and HEDIS.
- Recommends and implements program improvements that strengthen the MRR process and be able to present in a written report
- Review Roadmap for accuracy General Information, Appendix 1, and Section 4
Requirements and qualifications
- 1-3 years Demonstrated expertise in project coordination, office management, medical record collection, medical terminology, call center, creating, and managing central data repositories and data management systems for an office or large department
- Knowledge of medical terminology and basic charting
- Microsoft Publisher, Visio, Excel, PowerPoint, Share Point
- Able to think and work effectively under pressure
- The ability to function effectively within multidisciplinary teams
- Ability to accurately complete tasks within established times
- Ability to effectively prioritize multiple tasks and deadlines
ABC Company is looking for a HEDIS coordinator to join our population health team! The successful candidate needs to be reliable, trustworthy, motivated, a problem solver, and able to work independently and in a team environment.
Essential job functions
- 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
- Coordinate with clinical staff to inform them of missing screenings and HEDIS gaps
- Download patient records and upload them to insurance portals to close quality gaps.]
- Track inpatient and emergency room discharges and collect medical records from the corresponding healthcare facilities
- Fax release of information requests to necessary healthcare facilities
- Work with an automated system to upload records to patient charts
- Keep a log of inpatient and emergency room discharges
- Coordinate with clinical staff to inform them of patient hospital and emergency room utilization so proper follow-up steps can be taken by the clinic
- Contacts patients for appointments related to HEDIS non-compliance measures as needed
- Reliable attendance and presence at work
- Perform other work-related duties as assigned
- High School Diploma or GED required
- At least one (1) year of experience in HEDIS or a related field is a plus
- Strong knowledge of Microsoft Office Suite (Excel- basic mathematical formulas, charts, tables)
- Knowledge of CPT/ICD-9 & 10 & Medical Terminology
- Knowledge of NCQA HEDIS measures
- Goal-oriented, self-motivated, organized, team player, problem solver, etc.
- Aware of HIPAA rules regarding patient health information security
- Ability to meet and manage deadlines
- Medical background is a plus
How to Hire a HEDIS Coordinator
When hiring a HEDIS coordinator, first consider the following:
- Recruiting: Do you have the knowledge, tools, and resources to attract and screen candidates?
- Complexity: Do you need a senior professional, or will mid or junior-level skills and experience suffice?
- Duration: Is this a one-time project or an ongoing need?
- Management: Do you have the time and expertise to direct the work effectively?
- Urgency: How soon does the work need to be completed?
- Headcount: Do you have the budget and approval for an internal employee, or should you consider alternate options?
Answering these questions will help determine the best course of action for your current hiring need. Fortunately, great options exist for every scenario. These are our recommendations:
1. Use 4 Corner Resources (or another professional recruiting firm)
The heavy lifting is done for you when working with a top-tier staffing company like 4 Corner Resources. We source, screen, recruit, and deliver only the most qualified candidate(s), saving you significant time and effort throughout the hiring process while you remain focused on your core business. Understanding your needs and ensuring the right candidate for the position is the key to our success.
This is the best route to take when:
- You need to fill the position quickly
- You want access to a vast talent pool of high-quality, prescreened candidates
- Your position is suited for temporary hiring services, contract staffing, or contract-to-hire recruiting, and you intend to direct the work activity.
- You are hiring an employee as a direct placement but aren’t able to recruit effectively or efficiently with your internal staff.
- You aren’t familiar with current salary rates, market trends, and available skill sets
2. Advertise your opening on a top job board
Your best option may be to advertise your opening on a proven job board. There are many widely used job sites out there that draw visits from qualified candidates. If you have someone internally who can dedicate the time and energy to sort through applications and screen individuals effectively, this can be a great choice.
We recommend using a job board when:
- Your internal recruiting team has the knowledge and experience to assess candidate qualifications
- You are hiring a direct employee and have time to manage the entire recruiting effort
- You have a process for receiving, screening, and tracking all resumes and applications
- You are prepared to respond to all applicants
There are many career sites out there. Here are the two we recommend for a HEDIS coordinator opening:
LinkedIn is a social network for job seekers, professionals, and businesses. With this popular job site, you can enhance your brand and advertise your open position to a wide audience of motivated, qualified candidates. Job postings on LinkedIn are also extremely streamlined and user-friendly, making it even easier for candidates to apply. Additionally, applicants can use their LinkedIn profile instead of a resume to expedite the process.
CareerBuilder has been a trusted source for hiring since 1995. Reach 80+ million unique, diverse U.S. job seekers annually by posting your jobs through their talent acquisition channels. Through CareerBuilder, you can engage candidates and drive them into your sourcing pipeline. We recommend using CareerBuilder for hiring when you have the internal resources and processes to review, screen, and reply to all applicants.
3. Leverage your internal resources
You can utilize your own website, social media, and employees to assist in your search for top candidates.
A company website posting should be the first step in notifying prospective candidates that you are hiring. Social media can also be a powerful tool for spreading the word about your new opening. As far as exposure is concerned, this option can be as good as some job boards when you have a large enough following across various platforms, like LinkedIn, Instagram, Facebook, TikTok, and Twitter.
Current employees are every organization’s greatest asset. Encourage your internal team to promote job openings to their network by offering cash and other incentives.
We recommend these options when:
- Your brand has great name recognition
- You can consistently monitor and respond to candidate activity through your website and social media accounts
- You have a process in place to quickly and broadly communicate job openings and requirements
- You have an effective employee referral program in place
If you aren’t sure which path is best, schedule a discovery call today with our seasoned recruiting professionals. The 4 Corner team is on standby to help you find the best option for your unique hiring need.
Sample Interview Questions
- What does HEDIS stand for?
- Do you have any previous experience working in the HEDIS field, and any qualifications which might prove useful in this position?
- How would you go about improving the HEDIS scores, and ensuring the accuracy of the data presented?
- What is your previous background?
- Can you give one example of when your problem-solving skills helped with the successful operation of a HEDIS system?
- How many years have you worked with the HEDIS system?
- Can you tell me about the nursing background you have, if any? Do you believe this background will be beneficial to your operation in this position, and if so how?
- How familiar are you with HIPAA?
- Do you have experience working in a healthcare setting?