HEDIS Performance Improvement Coordinator
Corporate Headquarters - Chula Vista, CA
Community Health Group is a locally based non-profit health plan that ensures access to high quality, culturally sensitive health care for underserved communities throughout San Diego County. We treat our 300-member, multi-lingual staff like family, encouraging an atmosphere of collaborative teamwork, continuous learning, personal growth, and promotion from within. Recognized as one of the Top Workplaces in San Diego, CHG offers its employees such benefits as tuition reimbursement, a meditation room and yoga classes, a monthly Breakfast With The CEO, and memorable events throughout the year.
We know that by serving our employees well, they, in turn, will better serve our nearly 300,000+ membership. We have been recognized consistently for the excellence and sensitivity of our customer service by members, physicians, vendors, and a full range of health care providers. We are accredited by the National Committee for Quality Assurance and proud of our continuing company-wide Quality Initiatives.
We are currently recruiting for:
TITLE: HEDIS Performance Improvement Coordinator
EEO1: Administrative Support Worker
Responsible for the coordination and oversight of all HEDIS functions, including reporting, data validation processes, and provider outreach and monitoring. Provides guidance for complex analytics and reporting in support of internal HEDIS, Medicare Star and NCQA accreditation. Ensures compliance with all regulatory requirements related to HEDIS. Supervises HEDIS outreach staff.
COMPLIANCE WITH REGULATIONS:
Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal.
- Serves as a subject matter expert on HEDIS measures and the annual HEDIS process, as well as the Medicare Star program and annual rating process.
- Ensures all data sent to HEDIS software vendor are accurate and meet HEDIS reporting timeline.
- Identifies, plans for, communicates, monitors, and evaluates actions to comply with existing and new regulations, standards, and accreditation requirements.
- Conducts timely analysis of regulatory materials (CMS Call Letters, HEDIS Technical Specifications, NCQA requirements, etc.).
- Leads direct interventions with members and providers to address gaps in care.
- Develops, in collaboration with other departments, informational and training materials for providers and members.
- Consults and trains staff on measurement specifications and requirements.
- Provides oversight to HEDIS reporting and abstraction vendors and is the in-house abstraction project lead.
- Leads the annual HEDIS roadmap project and serves as subject matter expert with other departments to ensure claims, utilization, pharmacy, and enrollment data provided to auditors and regulators is accurate and timely.
- Manages the annual HEDIS reporting process and coordinates key functional areas to ensure compliance with standards.
- Assists with third party audits and serves as subject matter expert on identification of trends, practices, and training needs that hinder HEDIS performance.
- Analyzes HEDIS rates, compares to established benchmarks, and identifies opportunities for process improvement in health plan quality.
- Manages concurrent and retrospective data review processes, data abstraction, and measures performance metrics
- Helps compile status reports to Total Quality Integration team members and to senior executive level staff.
- Analyzes data for possible data integrity and data deficits.
- Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications, establishing and maintaining personal networks; participating in professional societies.
- Bachelors degree.in healthcare related field
- 2-3 Years HEDIS program experience required
- Able to monitor and meet program goals
- Comprehensive knowledge of standards; including HEDIS, STARs, CAHPS, HOS, and CMS.
- Prior STAR and HEDIS experience or participation with similar regulatory reporting.
- At least 3-5 years of healthcare experience to include experience in a managed care setting.
- Strong written and communication skills with the ability to write clear, structured, articulate, and persuasive improvement proposals.
- At least 3-5 years of experience with data analysis.
- Supervisory and/or management experience preferred.
- High level initiative, problem solving, and collaboration abilities
- Knowledge of Medicare and Medi-Cal regulations for managed care.
- Advanced experience using Microsoft office applications, including word-processing, and Excel.
- Experience working in deadline-driven environments.
- Prolonged sitting.
- Frequent traveling, including driving with County of San Diego.
- May be required to work evenings and weekends.
Community Health Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and trainings. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, see Personnel Policy 3101 Equal Employment Opportunity/Affirmative Action .