Position Title: Sr. HEDIS Specialist (Quality)
Reports To: Director of Quality & Accreditation
Status: Full-Time, Non-Exempt Pay: $29/hr DOE
Location:Remote or Onsite. Remote work eligibility limited to the following states: Idaho (ID), Montana (MT), Wyoming (WY), Tennessee (TN), Texas (TX), Missouri (MO), New Mexico (NM), Utah (UT), Arizona (AZ), Indiana (IN), Washington (WA), and New York (NY)
Position Summary:
Hi, we are Mountain Health Co-Op, the anti-insurance health insurance company. We serve members in Idaho, Montana, and Wyoming, and get this; our members are also the owners of this company because we are a co-op. We are proud to be a nonprofit that invests profits back into our membership through enhanced benefits and offerings. Yes, we make coverage cool.
Under the direction of the Director of Quality & Accreditation, the Quality Improvement Specialist supports the planning, implementation, and ongoing monitoring of all HEDIS program objectives. This position is all about improving our members’ health outcomes and impacting the Co-Op’s quality star rating. We are looking for an experienced candidate to provide HEDIS audit support including oversight of key vendors and overall project coordination during the annual regulatory audit. Off season activities will include project improvement initiatives, HEDIS outreach programs, medical record collection, and assisting with management of clinical records to support the conversion to digital reporting. This position is non-clinical in nature but will collaborate with clinical leadership and Quality department staff on projects that promote better health outcomes for our membership.
Duties and Responsibilities:
- Manage annual coordination of HEDIS audit deliverables
- Responsible for coordination completion and submission of annual roadmap documents
- Point of contact for HEDIS auditor
- Responsible for data integrity for all measures Manage HEDIS submissions in IDSS
- Takes a lead role in coordinating and monitoring the progress of all HEDIS improvement initiatives, including both provider and member outreach programs.
- Supports the transition to digital reporting through electronic record retrieval, coordination of PSV with providers, and conducts outreach to providers to increase electronic records access.
- Assists in the storing and managing of clinical records.
- Works with the Data team to support in-house HEDIS analytics needs.
- Works with department staff to plan and organize collaborative QI activities.
- Ensures timely updates of HEDIS workflow training guides.
- Other duties as assigned.
Knowledge, skills, and abilities:
(Minimum Requirements)
- College degree or equivalent work experience in the healthcare industry
- Three years of health plan experience supporting a HEDIS program
- One year of project management experience, certification in project management preferred
- Strong knowledge of healthcare operations Additional Experience:
- Experience working with health plan quality initiatives
- Familiarity with HEDIS measure specifications for the CMS Quality Rating System
- Medical coding knowledge
- Population health background preferred but not necessary
- Outstanding oral and written communication skills
- Strong analytical skills
- Ability to collaborate with various teams, internally and externally
- Computer application proficiency
**Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment visa at this time.
Travel
This position requires minimal travel within the Co-Op region of operations.
Physical Demands
While performing the duties of this job, the employee is regularly required to sit for extended periods of time and may be required to stand, walk, and stoop. The employee may occasionally lift and/or move up to 20 pounds of office supplies. Expressing or exchanging ideas by means of the spoken word requires the ability to receive detailed information through oral communication. Will be required to work for extended periods of time using a computer, keyboard, and mouse.
Mountain Health Co-Op is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.
Job Type: Full-time
Pay: $28.00 - $29.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
- Work from home
Schedule:
Work setting:
Experience:
- HEDIS: 3 years (Required)
Work Location: Remote