HEDIS Quality Specialist

2 weeks ago


Miami, United States Borinquen Health Care Center Full time
Borinquen Health Care Center Job Description

Job Title: HEDIS Specialist

Job Summary: We are seeking a highly organized and detail-oriented HEDIS Specialist to join our team at Borinquen Health Care Center. The successful candidate will be responsible for coordinating and completing HEDIS quality specific projects, ensuring consistency with our strategy, commitments, and goals.

Key Responsibilities:

  1. Coordinating and completing HEDIS quality specific projects
  2. Obtaining patient rosters from participating health insurance plans
  3. Calling patients to set appointments and evaluating quality management tabs, Avhana, and HEDIS
  4. Validating rosters, scheduling appointments, and ensuring compliance with quality measures
  5. Tracking quality measures and selling BHCC services as needed
  6. Assisting with chronic care management, sharing medical appointments, and completing care gaps
  7. Tracking hospitalization discharges and bringing patients for continuity of care
  8. Proactively seeking resources to identify gaps in existing or quality projects
  9. Performing other analyses to assist with documentation
  10. Periodically auditing records to confirm compliance with HEDIS and NCQA standards

Requirements:

  1. Associate's college degree
  2. Well-organized and bilingual (Spanish and/or Creole)
  3. Computer literacy with proficiency in Microsoft Office, including Outlook, Word, and Excel
  4. Ability to interact effectively with patients, administration, faculty, and staff
  5. Handle information with a high level of confidentiality
  6. Considerable knowledge of standard concepts, practices, and procedures within a field
  7. Relies on limited experience and judgment to make decisions, plan, and accomplish goals
  8. Minimum 1 year of customer service experience
  9. Strong interpersonal skills
  10. Bachelor's degree
  11. Experience in a clinical background setting (LPN, MA) with case management experience

Benefits:

  1. Medical, dental, vision, and short-term disability insurance
  2. Company-paid long-term disability insurance
  3. Life insurance
  4. 401K plan
  5. Standard paid holidays
  6. Vacation and sick time
  7. Amazing team and atmosphere


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