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