HEDIS Project Coordinator

US-LA-Metairie
Job ID
3496

Overview

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 to 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.

Responsibilities

Principal Responsibilities

  • Preparing the annual HEDIS Roadmap and submit to external auditor.
  • Preparing the interrator reliability testing and HEDIS measure training for chart auditors
  • Supporting 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 area
  • Conducting 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.);
  • Attends PHN meetings if requested;
  • Performs other duties as requested by the QI Director
  • 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 good working relationships with other departments
  • Excellent communication and organizational skills

 

Qualifications

Experience/Education

      • College Degree highly preferred
      • Must be familiar with database and report writing software
      • Aptitude for data management and analysis required
      • Strong problem solving skills also required
      • Strong interpersonal, organization, analytical and written skills needed
      • Must be flexible to meet time frames required to complete projects and must be able to work independently
      • 2 – 3 years related work experience with clinical reporting and HEDIS reporting highly preferred
      • Prior experience with medical claims processing and insurance software experience also preferred    

 

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