HEDIS Quality Performance Analyst

1 week ago


Rockledge, Florida, United States Health First Full time
Job Description

We are seeking a highly skilled HEDIS Quality Performance Analyst to join our team at Health First. In this role, you will be responsible for supporting regulatory compliance, CMS STARS, NCQA Accreditation, and other Revenue Operations clinical quality improvement programs.

Key Responsibilities:
  • Maintain up-to-date knowledge of CMS and AHCA guidelines, NCQA specifications, updates, and benchmarks.
  • Collect, abstract, and enter data, as well as perform performance improvement activities, to support quality initiatives.
  • Develop and maintain databases, research health plan encounter data, and track data for clinical and non-clinical quality performance improvement activities.
  • Represent the health plan at community and organizational meetings focusing on quality improvement, member education, care gap completion, risk reduction, and other areas.
Requirements:
  • Certified Professional Coder (CPC) certification within the first year of employment.
  • Three years of experience in healthcare, clinical quality, or related work experience.
  • Proficiency in healthcare-related applications, EMR, Word, Excel, and database management.
  • Able to abstract data, present it in clear reporting formats, and demonstrate attention to detail.
  • Knowledge of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry.
Preferred Qualifications:
  • Bachelor's degree in Health Sciences or a related field.
  • One or more years of experience in Managed Care or Quality Improvement.
Estimated Salary:

$64,000 - $80,000 per year, depending on experience.



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