HEDIS Project Coordinator

Job ID


Position Purpose

The HEDIS Project Coordinator is responsible for assisting the Director with the reporting of HEDIS data to NCQA, as well as coordinating data validation audits with external auditors to ensure accuracy and validity of collected data. 


Scope of Position

This position draws on knowledge of data from a variety of sources to assist in accurately reporting member outcomes to providers, regulatory agencies and accrediting bodies.


Principal Responsibilities

  • Assists in preparing the annual HEDIS Roadmap and submit to external auditor.
  • Organizes the interrator reliability testing and HEDIS measure training for Clinical Technicians
  • Monitors the completion and submission of all project activities to ensure time-lines are met. 
  • Responsible for generating reports supported by tables, charts, graphs, and text as applicable
  • Prepares and extracts all medical records as instructed
  • Accurately enters the extracted medical record(s) into data base
  • Conducts claims research, determining correct service location and/or member history
  • Conducts provider research to obtain medical record data
  • Supports the Quality Improvement Director in efforts associated with responding to quality improvement mandates by State, the Federal Government, Accreditation Groups (e.g. NCQA) and Employer Groups (e.g. Health Plan Employer Data Information Set a.k.a. HEDIS).
  • Assists in the oversight of Quality Improvement initiatives in the service and clinical areas.
  • Coordinates the medical record identification and missed quarterly reports
  • Conducts validation audits as directed by the QI Director to ensure the accuracy of the reported HEDIS measures each year as required by various regulatory agencies (i.e. CMS);
  • Supports the data needs of the QI Department to include compilation of Daily, Weekly, Monthly and/or Annual Reports;
  • In conjunction with the QI Director, revises data collection tools as required (i.e. Site surveys, and Medical Record Documentation audits etc.);
  • Provide administrative and project coordination support
  • Attends PHN meetings if requested;
  • Prepares quarterly reports for QPC or other groups as requested
  • Conducts biennial language survey with PH staff and providers
  • Scans Primary Source Verification and puts it into Macess

Core Competencies

  • Professionalism
  • Ability to develop and maintain effective working relationships
  • Excellent verbal and written communication skills
  • Organized; able to establish timelines and meet various deadlines
  • Ability to work independently
  • Flexibility with changing requirements and ability to adapt to changing priorities
  • Ability to resolve simple and/or complex analytical problems






  • Solid experience working with MS office applications, including ACCESS, Excel, Word and        Power-Point
  • Experience working with databases, queries, data extraction tools and report writing software
  • Prior experience working with projects from beginning through completion
  • Strong interpersonal, organization, analytical, and written skills necessary
  • Aptitude for data management and analysis
  • Strong problem solving skills
  • Must be able to work independently
  • Must be flexible to meet time frames required to complete projects
  • Strong research skills



  • College Degree in business, health administration or other related fields
  • Minimum of 2 years related work experience with clinical reporting, HEDIS reporting, process improvement, project management or quality management
  • Claims processing and/or insurance software experience preferred
  • Prior experience supporting compliance, auditing or process improvement highly preferred





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