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HEDIS/STARs Specialist/ San Diego Region


The Quality Management department is seeking a HEDIS/STARs Specialist to assist with provider engagement in the provider performance programs. This is a position that includes field work to train staff and providers as well as performing chart abstracts.

Duties and Responsibilities

  • Responsible for educating providers and their staff on HEDIS and STARs measures
  • Recommend workflow efficiencies to providers and their staff in an effort to improve HEDIS scores
  • Train providers and staff on health plan P4P incentive programs and track progress and make recommendations for success
  • Identifies member service gaps and reviews reports with providers and their staff
  • Collects medical records and reports from provider offices based on member needed services reports and gaps
  • Works directly with other HEDIS/STARs specialists at MedPOINT as well as health plan staff to monitor the gap closures and improvement activities
  • Assists the QM staff with physician and member interventions and incentive efforts as applicable
  • Participates in scheduled meetings with the MedPOINT QM Specialist team and vendors
  • Trains offices in enterprise wide HEDIS software program and track usage
  • Assist with member outreach efforts as directed
  • Submit actionable work plans to health plans and track progress
  • Supplemental data submission and tracking
  • Create and present provider training materials
  • Additional QM tasks as directed

Minimum Qualifications:

  • High school graduate or GED equivalent
  • Minimum of four years’ experience working in a quality department in health plan or IPA HEDIS environment
  • Working knowledge of NCQA HEDIS measure requirements
  • Willing to travel to provider offices throughout San Diego/ Imperial County

Knowledge, Skills and Abilities Required:

  • Effective verbal and written communication skills
  • Good interpersonal skills
  • Ability to multitask in a busy department
  • Able to work with large files and data sets
  • Excellent project management and organizational skills
  • Able to work well remotely in independent environment
  • Microsoft Office skilled (particularly with Word and Excel)
  • Working knowledge of navigating various computer programs
  • EZ-CAP® knowledge a plus

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Job title: HEDIS/STARs Specialist/ San Diego Region

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