HEDIS Quality Associate - Health First : Job Details

* This remote/hybrid position is primarily remote, with the flexibility to work from your home office. Periodic in-office attendance may be required for trainings, meetings or events.

POSITION SUMMARY

Contribute to Health First Health Plans (HFHP) HEDIS activities that support regulatory compliance, CMS STARS, NCQA Accreditation and other Value Capture clinical quality improvement programs. Assist in coordination of HEDIS and state-mandated quality measure data collection, abstraction, data entry and clinical chart review, as well as identify and participate in processes that enhance improvement in quality programs and the care of HFHP membership.

PRIMARY ACCOUNTABILITIES

* Maintain basic level knowledge of CMS and AHCA standards and guidelines, and NCQA specifications, updates and benchmarks.

* Maintain current knowledge of HEDIS and state-mandated quality metrics specifications, and proficiency with the vendor's reporting software to provide analytic support with data quality review, care gap analysis and reports.

* Support quality improvement programs and studies by requesting records from providers, maintaining databases, and researching health plan encounter data on an ongoing basis.

* Assist with tracking data for clinical and non-clinical quality performance improvement activities and identify trends.

* Perform continuing medical record evaluation and follow-up education as required.

* Accurately review, abstract and data enter HEDIS data from qualified medical records per established guidelines and internal protocols.

* Assist in process improvement implementations to maximize STARS ratings.

* Assist in ensuring financial impact to organization as well as data submitted for Risk Adjustment and HEDIS measures is complete, accurate and thorough to mitigate risk of regulatory agency audits.

* Participate in special projects as requested by leadership and assist in identifying opportunities for operational improvements consistent with Health First and Value Capture strategic goals.

MINIMUM QUALIFICATIONS

* Education: Bachelor's degree in health sciences or related field.

* Licensure: None required

* Certification: None required

* Work Experience: 3 years' experience in health care, clinical quality, or related work experience.

* Work Experience in lieu of Education: Additional 4 years' experience in health care, clinical quality, or related work experience.

* Knowledge/Skills/Abilities:

* Proficiency in health care related applications, EMR, Word, Excel, and a basic understanding of database management.

* Ability to abstract data, and present data in clear reporting formats to support comparison and analysis.

* Knowledge base of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry.

* Solid mathematical skills and demonstrate accuracy in tabulation of data and calculation of rates based on defined numerators/denominators.

* Analytical skills sufficient to assess and identify variations in data and processes.

* Ability to evaluate medical records and data with attention to detail.

* Experience monitoring policies, internal control procedures and operating standards.

* Exceptional interpersonal relationship skills.

* Basic knowledge of HEDIS and/or Risk Adjustment.

PREFERRED QUALIFICATIONS

* Licensure: RN preferred, other related clinical degrees and/or licensure may be considered.

* Certification: Certified Professional Coders certification (CPC).

* Work Experience: One year in Managed Care setting or Quality Improvement experience.