Job Title
HEDIS Coordinator (Healthcare Effectiveness Data and Information Set)
Reports To
The HEDIS Coordinator position will report directly to the Clinical Quality Manager.
Position Summary
Assists providers, supervisors, and staff members with all aspects of the Medicare Advantage plans and other value-based programs, including Accountable Care Organization Will close care gaps/Healthcare Effectiveness Data Information Set (HEDIS) measures for participating insurance companies. Reporting all quality measures to the insurance, auditing charts, and working reports. Works with Medicare Advantage and other value-based patient populations to achieve goals on each value-based agreement.
Essential Functions & Responsibilities
Performs medical chart reviews to look for gaps in care.
- Filters reports to work efficiently.
- Documents on the report status of each item if complete, pending, and N/A.
- Identifies any patients that are no longer part of UCF Health (transfer care).
- Audits patient charts efficiently and accurately.
- Assists with outside chart audits and submitting or required information as needed. Submitting/reporting patient information to various health plans via their portals as directed.
Assists with various aspects of the HEDIS process.
- Understands the quality measures and criteria.
- Understands how the measure is met and documentation required.
- Logs in to insurance portal to properly report if a measure has been met.
- Adheres to strict guidelines for reporting measures, using proper CPTII codes.
- Documents appropriately and only necessary medical information relating to closing care gaps and HEDIS measures.
- Trains staff on creation and maintenance of admission logs
- Trains staff on use of remote access to Hospital sites
Coordinates with physicians and clinical staff to inform them of missing screenings and HEDIS gaps.
- Monitors designated Telephone Encounter (TE) Pool and document updates and future appointments in TE Pool.
- Works with scheduling team to ensure patients are scheduled for Annual Medicare Wellness and Physical.
- Sends TE’s to physician requesting an order for mammogram, labs or referral for colonoscopy, eye exam when needed. Then notifying patient the order was creating and send to patient or facility.
- Notifies physician and clinical when patient’s next appointment is at the office and what gap
Reports to the Clinical Quality Manager for weekly meeting to review progress and concerns.
Performs other job-related duties as assigned.
- Attends required staff meetings and in-service.
- Adheres to HIPAA guidelines/regulations/annual HIPAA training.
Education
- (1) A two-year college degree or (2) completion of a specialized course of study at a business or trade school or (3) completion of specialized training courses conducted by equipment vendors or (4) job specific skills acquired through on-the-job training or apprenticeship program.
Work Experience
- One to three years of similar or related experience.
Knowledge
- Sound knowledge of medical terminology
- HEDIS requirements preferred.
Skills/Abilities
- Well organized with the ability to keep accurate notes and records.
- Excellent oral and written communication abilities.
- Good interpersonal and public relations skills.
- Solid problem-solving skills.
- Attention to detail.
Benefits: Benefits Eligible
