Job #: 2149
Title: HEDIS Quality Manager
The Quality Specialist is responsible for the planning, coordination and collection of HEDIS data and outreach activities. Provides expertise in business requirements for HEDIS data reporting and analysis. The function also includes identifying and obtaining medical records for gaps in care and recommending ongoing improvement and maintenance.
Duties and Responsibilities:
• Review and submit data relating to HEDIS and other Quality reports.
• QA review of all HEDIS input and output files. • Coordinate production of file with external vendor.
• Generate and trend reports from data warehouse and HEDIS software.
• Monitor HEDIS software releases. • Coordinate HEDIS road map with departmental leads and external vendors.
• Request medical records from provider offices. • Monitor faxed requests for records and replies.
• Generate gaps in care reports and coordinate with Care Management.
• Develop and maintain working relationships with internal and external customers.
• Prioritize and complete assigned projects timely.
• Conduct telephone audits on contracted vendors.
• Conduct disenrollment calls.
• Analyze disenrollment reasons and trend reports.
• All other job duties as assigned.
• 1-3 years of recent medical record review / abstraction required. • Bachelor’s degree in healthcare related field required.
• Current licenses and registration to practice in the state of New York as an LPN or RN preferred.
• Minimum of 2 years managed care experience required.
• Knowledge of HEDIS software preferred
• Strong written and verbal communication skills required.
• Efficient in Microsoft word and excel required.
• Excellent organizational skills with an attention to detail required.
• Ability to handle multiple projects simultaneously.