HEDIS Specialist

4 weeks ago

Raleigh, North Carolina, United States Spectraforce Technologies Full time
HEDIS Specialist Job Description

At Spectraforce Technologies, we are seeking a highly skilled HEDIS Specialist to join our team. As a HEDIS Specialist, you will play a critical role in improving compliance with key behavioral health HEDIS metrics and Pay for Performance (P4P) Measures.

Key Responsibilities:
  • Develop and implement innovative strategies in collaboration with clinical staff to improve compliance with key behavioral health HEDIS metrics and P4P Measures.
  • Prepare and present financial impact and return on investment on initiatives requiring additional funding or resources.
  • Act as a liaison with quality improvement, health plan medical management and other departments regarding current and planned interventions, collect input on how to impact these outcomes, and provide feedback to stakeholders on outcomes.
  • Monitor the effectiveness for new and existing P4P and HEDIS initiatives and ensure appropriate knowledge/education and interventions are conducted for members falling into these measures.
  • Analyze data to address trends or potential quality and clinical improvement opportunities based on best practices and feedback from involved stakeholders.

Requirements:
  • Associate's degree or relevant 2+ years' medical and HEDIS experience.
  • Electronic Medical Record (EMR) navigation experience.
  • HEDIS Project experience.
  • Ability to be productive independently in a remote environment.
  • Experience abstracting data from medical records.
  • Healthcare experience in medical terminology, medical record review, coding, or similar experience.
  • HEDIS knowledge.
  • Ability to adapt to changing priorities in managing a wide range of projects.
  • Attention to detail.
  • Remote Access EMR record retrieval experience.

Additional Information:
  • Complete training and testing in the required timeframe with a satisfactory pass rate.
  • Communicate and collaborate with coworkers, team leads and manager.
  • Follow HIPAA and company guidelines to safeguard PHI and PII.
  • Utilize company equipment in a private, secured, at home location using wired cable, fiber, DSL or BPL internet.