Sr. HEDIS Coordinator

3 weeks ago

Mclean, United States Somatus Full time

Overview

As the largest and leading value-based kidney care company, Somatus is empowering patients across the country living with chronic kidney disease to experience more days out of the hospital and healthier at home.

It takes a village of passionate and tenacious innovators to revolutionize an industry and support individuals living with a chronic disease to fulfill our purpose of creating More Lives, Better Lived. Does this sound like you?

Showing Up Somatus Strong

We foster an inclusive work environment that promotes collaboration and innovation at every level. Our values bring our mission to life and serve as the DNA for every decision we make:

* Authenticity: We believe in real dialogue. In any interaction, with patients, partners, vendors, or our teammates, we are true to who we are, say what we mean, and mean what we say.
* Collaboration: We appreciate what every person at Somatus brings to the table and believe that together we can do and achieve more.
* Empowerment: We make sure every voice gets heard and all ideas are considered, especially when it comes to our patients' lives or our partners' best interests.
* Innovation: We relentlessly look for ways to improve upon the status quo to continuously deliver new solutions.
* Tenacity: We see challenges as opportunities for growth and improvement - especially when new solutions will make a difference for our patients and partners.

Showing Up for You

We offer more than 25 Health, Growth, and Wealth Work Perks to help teammates learn, grow, and be the best version of themselves, including:

* Subsidized, personal healthcare coverage (medical, dental vision)
* Accrual of 3 weeks' Vacation (PTO)
* Professional Development, CEU, and Tuition Reimbursement
* Curated Wellness Benefits supporting teammates physical and mental well-being
* Community engagement opportunities
* And more

The Sr. HEDIS Coordinator will perform the functions related to the outreach, collection, and accurate data entering of medical records and service data according to HEDIS / Somatus Technical Specifications. The primary focus of this role will be to analyze and process the information collected and review the applicable medical records and clinical criteria.

Responsibilities

* Coordinate, complete, and update management on all HEDIS processes and results.
* Work with providers and internal departments on rate investigation and validation activities, which includes maintaining all evidence, documentation, and changes.
* Call patients to schedule appointments, develop recommendations for quality improvement activities for our providers and collaborate with other departments on these activities.
* Complete post ED / post hospital follow up with patients.
* Complete review of medical records received from providers and be responsible for attestations within contract portals.
* Engage positively with members, peers, and clinic staff.
* Collect and enter clinical information from medical records into various tools and databases in accordance with HEDIS technical specifications as well as Somatus and health plan specifications.
* Remain updated on NCQA HEDIS Technical Specifications as it applies to Somatus and partner health plan quality programs.
* Interface with data support, quality assurance team, HEDIS Quality Manager, and IT to collect data and maintain the various health plan tools.
* Filing, faxing, copying, and scanning of files.
* Strive to meet personal, departmental, and organizational goals and targets.
* Complete assignments within specified timelines.
* Prepare and maintain records and files that are organized, thorough and readily accessible.
* Attend team meetings and report findings of data collection as well as barriers or opportunities.
* When a problem is identified, inform supervisor in a timely manner.
* Transmit ideas and information in a clear and concise manner.
* All other duties as directed by management.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Qualifications

Required

* LPN/ LVN


* 1 year HEDIS or other comparable experience



Preferred

* Three year experience in clinical setting

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 Vaccination is required for employment. If you are unable to be vaccinated for medical reasons or sincerely-held religious beliefs, we will consider requests for reasonable accommodations consistent with our policy, and where we are able to provide such accommodations without undue hardship to the company pursuant to applicable law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Somatus, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Further, the company takes affirmative action to ensure that applicants are employed, and employees are treated during employment without regard to any of these characteristics. Discrimination of any type will not be tolerated.

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