Essential Job Functions: Team Leadership and Performance Management 20% Lead, coach, and develop a team of HEDIS Abstractors and Quality Operations staff. Provide daily oversight, mentoring, and quality assurance to ensure abstraction accuracy, data consistency, and adherence to performance standards. Foster a culture of accountability, continuous improvement, and professional growth. Operational Oversight and Data Quality Management 20% Direct the execution and optimization of HEDIS and supplemental data workflows, including ingestion, validation, and reconciliation. Ensure data accuracy, completeness, and timeliness to meet payer, regulatory, and internal reporting requirements. Cross-Functional and External Collaboration 20% Serve as a key liaison with payers, analytics, IT, and regional quality teams to address data discrepancies, drive operational alignment, and strengthen cross-functional coordination. Represent Quality Operations in payer discussions and collaborative meetings to enhance reporting outcomes and compliance. Strategic Process Improvement and Audit Readiness 20% Identify operational inefficiencies, lead process improvement initiatives, and oversee audit readiness activities, including primary source validation and payer data verification. Develop and maintain process documentation, productivity metrics, and dashboards to track progress toward quality and Stars performance goals. Leadership in Quality Strategy and Innovation 20% Partner with senior leadership to shape and execute strategic initiatives that elevate HEDIS and Stars performance across value-based care markets. Drive innovation in quality operations through enhanced workflows, data-driven insights, and best practice implementation. Other Job Functions: Other duties as assigned.
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Job Type
Full-time
Career Level
Mid Level