HEDIS Coordinator Sample Job Descriptions

[Your Company Name] is looking for an experienced HEDIS coordinator! If you have previous experience working with the healthcare effectiveness data and information set or are a quick learner with previous experience in the healthcare field, we want you! Your job will be to accurately assess, record, and parse the information presented by the HEDIS system. You will also be required to coordinate the HEDIS process and establish successful methods by which to determine the performance and success of medical treatments. A bachelor’s degree in the medical field is required for this position. The ideal candidate must be data-minded and driven. The candidate must also possess the ability and knowledge to create and organize a plan of action in order to improve the healthcare effectiveness data and information set success scores. If this sounds like it’s you, please don’t hesitate to apply for this position.

Typical duties and responsibilities

• Update clinical quality metrics
• Coordinate HEDIS processes and establish 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
• Maintain all data and process controls to ensure compliance

Education and experience

This position requires a bachelor’s degree in a science- or medical-related field. HEDIS certification is preferred by employers, as is 3+ years of quality-improvement or health care experience.

Required skills and qualifications

• Excellent verbal and written communication skills
• Strong organizational skills with the ability to keep accurate notes and records
• Proficient in Microsoft Office Suite
• Possess leadership capabilities

Preferred qualifications

• Bachelor’s or master’s degree in health
• 3+ years experience working as a HEDIS coordinator
• Experience with the HEDIS system

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.

Basic function

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.

Job requirements

• 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

Duties

• 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

Education and experience

• 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

Performance requirements

• 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