HEDIS Specialist

Borinquen Health Care Center is seeking a highly skilled HEDIS Specialist to play a critical role in ensuring the highest quality of care for our patients. As a HEDIS Specialist, you will be responsible for communicating provider participation information to internal and external customers, verifying and updating patient registration information, and working collaboratively with all departments to resolve registration issues.

• Coordinating and completing HEDIS quality specific projects to ensure consistency with Borinquen Health Care Center's strategy, commitments, and goals.
• Obtaining patient rosters from participating health insurance plans.
• Calling patients to set appointments, evaluating quality management tabs, Avhana, and HEDIS.
• Validating rosters, scheduling appointments, and ensuring compliance with quality measures.
• Tracking quality measures and selling BHCC services if needed, determining the reason for appointments.
• Tracking Medicare population utilization.
• Assisting with Chronic Care management (CCM), sharing medical appointments, completing care gaps, and assisting with group visits.
• Tracking hospitalization discharges and bringing patients for continuity of care.
• Proactively seeking resources to identify gaps in existing or quality projects as they arise.
• Performing other analyses to assist with documentation.
• Periodically auditing records to confirm compliance with HEDIS and NCQA standards.

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

Borinquen Health Care Center offers a competitive benefits package, including medical, dental, vision, short-term disability, company-paid long-term disability, life insurance, 401(k) plan, standard paid holidays, vacation, and sick time, as well as an amazing team and atmosphere.