Coordinator HEDIS Nonclinical

Amerihealth Caritas•,

2d•Hybrid

About The Position

The HEDIS Coordinator, under the direction of the Lead HEDIS Reviewer, is responsible for participating in and providing guidance and support for the development and maintenance of the HEDIS Medical Record Review platform(s). This role involves coordinating ongoing medical record collection and archiving of documents, collaborating within the department to maintain various program materials, and supporting process improvement initiatives related to the medical record review process. The coordinator will also manage meeting schedules, take notes, and distribute materials. Key tasks include filing invoices, printing pull lists, and managing incoming medical records from fax, email, and mail. A significant part of the role involves conducting outreach to providers to validate information, schedule appointments, and follow up on pull lists. The coordinator will develop expertise in HEDIS and state performance measures, perform structured auditing abstraction to determine compliance, and maintain an abstraction proficiency rate of 95%. This includes analyzing data, identifying trends, making recommendations for improvement, and presenting findings. The role also involves reviewing Roadmap sections for accuracy and completing additional projects as assigned.

Requirements

High School diploma or GED required.
1–3 years of demonstrated experience in project coordination, office management, medical record collection, medical terminology, call center operations, and creating and managing central data repositories and data management systems for an office or large department.
Knowledge of medical terminology and basic charting.
Experience with Outlook, Excel, PowerPoint, Word, MS Teams, OneNote, and SharePoint.
Strong written and verbal communication skills, critical thinking skills, and organizational abilities.
Ability to think and work independently, effectively, and under pressure with tight deadlines.
Ability to function effectively within multidisciplinary teams.
Ability to accurately complete tasks within established timeframes.
Ability to effectively prioritize multiple tasks and deadlines.

Nice To Haves

Associate’s degree preferred but not required.
Experience with HEDIS (Healthcare Effectiveness Data and Information Set).
Experience working with EMR (Electronic Medical Record) systems.
Experience with claims processing and healthcare claims workflows.

Responsibilities

Participating in and providing guidance and support for the development and maintenance of the HEDIS Medical Record Review platform(s) to support all plans.
Coordinating the ongoing medical record collection and archiving of documents that support medical record review projects, regulatory audits, and accreditation standards.
Working collaboratively within the department to maintain the SharePoint site, drives, medical records, blogs, newsletters, and other program and project materials as deemed necessary.
Participating in and supporting process improvement initiatives related to the medical record review process across the enterprise.
Coordinating meeting calendars, facilitating meetings as directed, and participating in appropriate meetings, including notetaking and material distribution.
Filing company invoices, printing pull lists from medical record review tools, and saving them to appropriate locations per defined processes.
Pulling incoming medical records from fax and email queues and saving them to appropriate locations per defined processes.
Scanning incoming medical records received via mail or onsite visits and saving them to appropriate locations per defined processes.
Conducting outreach to providers to support HEDIS and other medical record review projects, including—but not limited to—validation of fax numbers, provider office locations, HEDIS contact information, scheduling onsite retrieval appointments, maintaining and following up on pull lists, and investigating additional documentation requirements.
Developing and maintaining expertise in the requirements and parameters of mandated HEDIS and state performance measures.
Performing and applying structured auditing abstraction criteria to medical records to determine compliance for measures, as directed.
Maintaining an abstraction proficiency rate of 95% by correctly reading, interpreting, and abstracting various components of the medical record, such as notes, consultations, medication forms, treatment plans, health history, interval history, and past history.
Assisting in the medical record collection process, including making phone calls, sending faxes and letters, and retrieving charts from providers as assigned.
Analyzing data, including statistical analyses; identifying trends; and making recommendations for improvement of practices and processes related to Medical Record Retrieval (MRR) and HEDIS. Recommending and implementing program improvements that strengthen the MRR process and presenting findings in written reports.
Reviewing applicable or assigned Roadmap sections for accuracy.
Completing additional projects as assigned and deemed necessary.