HEDIS Quality Coordinator

• Contact provider offices to request medical records and/or schedule appointments to visit provider offices for medical record collection.
• Collect medical records through copying or uploading to portable drives, and subsequently upload them to the DCHP record repository.
• Perform medical chart reviews to identify gaps in care, such as missing mammograms, preventive screenings, and other HEDIS-related measures.
• Conduct educational training sessions with provider office staff to inform them of changes and updates to HEDIS measures and guidelines.
• Collaborate with provider office staff to identify members with open gaps in care and provide necessary information and support to close these gaps.
• Conduct member outreach to educate and assist in completing identified preventive care measures.
• Communicate effectively with members and network providers, facilitating the scheduling of appointments to ensure members receive necessary healthcare services.
• Perform provider outreach to support HEDIS and medical record retrieval projects, including validating fax numbers, verifying provider office locations, obtaining HEDIS contact information, and scheduling onsite retrieval appointments.
• Engage in member outreach via phone to assist members in closing gaps in care, completing Health Risk Assessments (HRA), identifying barriers to care, and helping members overcome and resolve these barriers.
• This position requires considerable driving throughout Miami-Dade and Broward Counties to visit provider offices, therefore, the applicant must have reliable transportation. 

• Excellent customer service, phone, and communication skills.
• Ability to work independently and as part of a team.
• Experience in making outbound calls, preferable in a call center environment or similar setting is required.
• Strong computer literacy, including proficiency with electronic medical record systems.
• Familiarity with HEDIS measures, healthcare regulations, and medical terminology is preferred.
• Experience in a healthcare setting, particularly in medical records, quality improvement, or care coordination, is advantageous.
• Detail-oriented with strong organizational and time management skills.
• Ability to handle confidential and sensitive information with discretion.
• Bilingual in English and Spanish is required.

• High school diploma or equivalent required; Associate’s or Bachelor’s degree in a healthcare-related field preferred.
• Minimum of 1-2 years of experience in a healthcare setting, with a focus on medical records, quality improvement, or similar areas preferred.

Last updated on Nov 19, 2024