HEDIS Specialist
On-siteMiami, Florida, United States
Job Summary
Coordinate HEDIS quality projects and audit records to ensure compliance with HEDIS and NCQA standards. Obtain patient rosters from insurance plans, validate data, and schedule appointments while tracking quality measures and care gaps. Call registered patients to set appointments, evaluate quality management tabs, and ensure adherence to standard care guidelines. Track Medicare utilization, hospitalization discharges, and chronic care management activities to maintain continuity of care. Provide paneling information to health plans and perform chart audits when requested. This role requires a Bachelor's degree, bilingual skills, and experience in a clinical background setting. Full-time employment with benefits including medical, dental, vision, and 401K.
Required Qualifications
- Associates college degree
- Well organized
- Bilingual (Spanish and/or Creole)
- Computer literacy with proficiency and expertise in Microsoft Office, including Outlook, Word, and Excel
- Ability to interact effectively with patients, administration, faculty, and staff
- Handle information with high level of confidentiality
- Considerable knowledge of standard concepts, practices, and procedures within a field
- Relies on limited experience and judgment to make decision, plan and accomplish goals
- Minimum 1 year of customer service
- Strong interpersonal skills
- Bachelor's Degree
- Experience in clinical background setting (LPN, MA) with case management experience
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