We’re looking to hire a HEDIS Coordinator for HEDIS measures. The main role of the HEDIS Coordinator for HEDIS measures is to ensure all managed care patients are compliant with yearly preventive screenings. To provide excellent customer service to patients and facilitate outreach services and clinical services to our managed care population.
- Facilitates member outreach to ensure member receipt of important clinical services to improve member health outcomes.
- Provides support for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives and regulatory/contractual requirements including outreach to members who are noncompliant in the designated outreach services.
- Supports effective medical record capture for HEDIS medical record review and abstraction of supplemental data.
- Identifies potential resources and initiates collaboration with providers to improve member health outcomes and HEDIS measures.
- Makes outbound calls to members to provide assistance in obtaining services (i.e., provide reminders, make appointments, arrange transportation, etc.) to avoid delays in treatment and improve member health outcomes.
- Help identify when to refer member to Social Worker or Case Manager.
- Develops and distributes educational information to members and providers in accordance with the HEDIS outreach work plan (mailings, social media, automated calls, etc.)
- Assists in the development and standardization of outreach documentation and manages the data flow process to complete HEDIS documentation.
- Documents member participation in outreach activities in accordance with abstraction and audit standards.
- Conducts HEDIS provider chart request calls and mailings.
- May develop and maintain member incentive programs to support HEDIS initiatives.
- Records and documents all member and provider outreach activity.
- Performs other duties as required.
- Minimum 3 years’ recent and related health care marketing, outreach and/or health education experience.
- Recent and related experience working with HEDIS criteria
- Strong communication skills and experience speaking with medical providers.
- Ability to work independently.
- Ability to use standard corporate software packages and corporate applications.
- Bilingual a Plus
- Associate’s degree or equivalent experience