HEDIS Coordinator
Spectraforce TechnologiesWichita, KS, United States2 days ago
Job type
- Full-time
Job descriptionMonitor / manage incoming records during HEDIS Hybrid season. Working w / vendor portals and HEDIS hybrid chart chase engine (training provided). Investigate and contact providers to confirm demographic information. Review claims database for evidence of date of service. Potential for rate max of medical records for compliance with HEDIS standards (depending on experience). Medical Record Experience Health care or MCO experience Strong computer program and navigational skills (excel, outlook, etc) HEDIS or NCQA knowledge Claims Experience Datavant / Ciox portal experience Provider outreach call experience
Title : HEDIS Coordinator
Duration : 1.5 Months (possibility of extension)
Location : Remote
- Establish and maintain an action plan to improve HEDIS scores
- Implement process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities
- Collaborate with providers and internal departments on rate investigation and validation activities, including maintaining all evidences, documentations, and changes
- Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality
- Conduct quality audit and maintain all data and process controls to ensure compliance
Duties include :
Education / Certification
High School Diploma
Must haves :
Nice to haves :