Healthcare Quality Coordinator

7 days ago

Miami FL USA, United States DOCTORS HEALTHCARE PLANS, INC. Full time
Job Title: Quality/Hedis Coordinator

Doctors Healthcare Plans, Inc. is seeking a highly skilled Quality/Hedis Coordinator to support our Healthcare Effectiveness Data and Information Set (HEDIS) annual medical record collection project.

Key Responsibilities:
  • Retrieve and review medical records to ensure compliance with HEDIS measures.
  • Make outbound calls to members to close gaps in care and complete Health Risk Assessments (HRAs).
  • Contact provider offices to request medical records and/or schedule appointments for medical record collection.
  • Collect medical records through copying or uploading to portable drives and upload them to the DCHP record repository.
  • Perform medical chart reviews to identify gaps in care, such as missing mammograms, preventive screenings, and other HEDIS-related measures.
  • Conduct educational training sessions with provider office staff to inform them of changes and updates to HEDIS measures and guidelines.
  • Collaborate with provider office staff to identify members with open gaps in care and provide necessary information and support to close these gaps.
  • Conduct member outreach to educate and assist in completing identified preventive care measures.
  • Communicate effectively with members and network providers to facilitate the scheduling of appointments to ensure members receive necessary healthcare services.
  • Perform provider outreach to support HEDIS and medical record retrieval projects, including validating fax numbers, verifying provider office locations, obtaining HEDIS contact information, and scheduling onsite retrieval appointments.
  • Engage in member outreach via phone to assist members in closing gaps in care, completing Health Risk Assessments (HRA), identifying barriers to care, and helping members overcome and resolve these barriers.
Qualifications:
  • Excellent customer service, phone, and communication skills.
  • Ability to work independently and as part of a team.
  • Experience in making outbound calls, preferably in a call center environment or similar setting.
  • Strong computer literacy, including proficiency with electronic medical record systems.
  • Familiarity with HEDIS measures, healthcare regulations, and medical terminology is preferred.
  • Experience in a healthcare setting, particularly in medical records, quality improvement, or care coordination, is advantageous.
  • Detail-oriented with strong organizational and time management skills.
  • Ability to handle confidential and sensitive information with discretion.
  • Bilingual in English and Spanish is preferred, but not required.
Education and Experience:
  • High school diploma or equivalent required; Associate's or Bachelor's degree in a healthcare-related field preferred.
  • Minimum of 1-2 years of experience in a healthcare setting, with a focus on medical records, quality improvement, or similar areas preferred.

Doctors Healthcare Plans, Inc. is an equal opportunity employer and welcomes applications from diverse candidates. We are committed to creating a diverse and inclusive work environment.

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