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HEDIS Program Coordinator

2 months ago

French Camp, California, United States SAN JOAQUIN COUNTY HEALTH COMMISSION Full time
Position Overview

Salary Range: The anticipated compensation is influenced by various factors including location, experience, education, and market trends. This range may be adjusted.

Position Type: Remote - Candidates must reside in California.

Key Responsibilities:

This role is pivotal in managing the HEDIS and NCQA initiatives for the organization, ensuring timely completion of essential tasks. The coordinator will work collaboratively with various internal departments to guarantee that all accreditation standards are consistently met through ongoing review, auditing, and monitoring of requirements. Responsibilities include:

  • Partnering with the Quality Improvement team and leadership to identify quality challenges and root causes, facilitating intervention strategies.
  • Engaging with both internal teams and external contacts to assess, communicate, and support non-compliant members and providers.
  • Overseeing the timely preparation, completion, and submission of necessary documentation to auditors for NCQA and HEDIS, in alignment with the organization's calendar.
  • Managing medical record requests in compliance with HIPAA regulations and organizational policies.
  • Organizing educational sessions for medical groups and physicians regarding issues identified during quality improvement and HEDIS processes.
  • Updating and maintaining the annual HEDIS and NCQA measures matrix and providing quarterly updates to department heads.
  • Assisting in the execution of the HEDIS project plan based on established guidelines and securing necessary approvals.
  • Monitoring project timelines and progress, escalating issues to supervisors as needed.
  • Collaborating with HEDIS staff and relevant department heads to develop a comprehensive HEDIS roadmap, making recommendations for adjustments as necessary.
  • Coordinating medical record reviews and data abstraction with both internal and external personnel.
  • Serving as the primary liaison for HEDIS/NCQA vendors concerning data operations, logic adjustments, system issues, and report submissions.
  • Conducting medical record reviews focused on immunization data abstraction, aggregation, and analysis.
  • Facilitating the preparation and distribution of HEDIS training and educational materials for staff and network providers.
  • Compiling various reports for internal and external stakeholders, obtaining necessary approvals, and distributing them as required.
  • Ensuring timely collection of documents and completion of required member surveys.
  • Analyzing reports and ensuring they are submitted by responsible parties in accordance with the NCQA activities calendar.

Qualifications:

Knowledge, Skills, and Abilities:

  • Detail-oriented with a focus on accuracy and completeness.
  • Ability to produce a high volume of work efficiently.
  • Proficient in learning through experience, adapting to new challenges.
  • Resilient in overcoming setbacks and challenges.
  • Strong understanding of HEDIS processes and NCQA accreditation.
  • Basic knowledge of quality management principles and healthcare industry practices.
  • Effective communication skills, both written and verbal, with the ability to engage diverse groups.
  • Strong organizational and time management skills.
  • Ability to work independently and collaboratively within a team.
  • Proficient in Microsoft Office, particularly Excel.

Education and Experience:

Required:

  • High school diploma.
  • Minimum of two years of experience in HEDIS process coordination or NCQA accreditation.
  • At least three years of experience in an administrative role within a healthcare environment, or an equivalent combination of education and experience.

Preferred:

  • Experience in managed care or quality improvement is highly desirable.

Benefits:

  • Competitive salary and comprehensive health benefits.
  • Generous paid time off and holidays.
  • Retirement pension program with employer contributions.
  • Flexible spending accounts and additional insurance options.
  • Opportunities for professional development and training reimbursement.

We are committed to diversity and equal opportunity in employment. Our organization values the unique perspectives and contributions of all individuals.