HEDIS/STARs Specialist

Summary

The Quality Management department is seeking a HEDIS/STARs Specialist to assist with all levels of provider engagement in performance programs. This is a position that may include field work in the future to train staff and providers as well as perform chart abstracts.

Duties and Responsibilities

  • 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, track progress and make recommendations for success
  • Identify member service gaps and review reports with providers and their staff.
  • Collects medical records and reports from provider offices based on open member care gaps.
  • Works directly with other MedPOINT HEDIS/STARs specialists as well as health plan staff to monitor gap closures and improvement activities.
  • Actively participates in scheduled meetings with MedPOINT QM Specialist team and health plan JOMs.
  • Handle incoming calls from providers and provider staff to answer questions regarding quality metrics
  • Coordinate quality initiative projects for various groups and perform follow up and outcome determination.
  • Trains offices in enterprise wide HEDIS software program (Cozeva) 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.
  • Participate in supplemental data overreading as needed.
  • Create and present provider training materials to individuals as well as in small and large group settings.
  • Additional QM tasks as directed.

Minimum Job Requirements

  • 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 technical specifications.
  • Current CA drivers license.
  • Willing to travel to provider offices throughout Los Angeles if and when COVID travel restrictions lifted.

Knowledge, Skills and Abilities Required

  • Effective verbal and written communication skills
  • Excellent interpersonal skills
  • Ability to multitask in a busy department.
  • Innovative critical thinker.
  • Ability to work independently and productively in remote setting.
  • Able to manipulate and analyze large files and data sets.
  • Excellent project management and organizational skills
  • Intermediate to advanced skills with Microsoft Office Products (particularly with Word and Excel).
  • EZ-CAP® knowledge a plus

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