HEDIS Coordinator

DRISCOLL HEALTH PLAN•Corpus Christi, TX

About The Position

The HEDIS Coordinator is responsible for the identification, initiation, development, implementation, validation, and sustainability of data, work processes, and initiatives intended to enhance the availability and use of electronic clinical data as it relates to DHP Quality performance metrics. This position reports to the Manager of Performance Metrics and works with internal and external stakeholders to develop, implement, monitor, and report quality initiatives and business processes which drive quality data capture.

Requirements

Bachelor’s degree in health administration, Business Administration, Information Systems, Health Care, or health-related field required.
Proficient knowledge of Microsoft Office products, including Word, Excel, Outlook, and PowerPoint.

Nice To Haves

Master’s degree in a health-related field preferred.
Knowledge of National Committee on Quality Assurance (NCQA) specifications for HEDIS® audits, the managed care environment, and the basic tenets of quality improvement are strongly preferred.
Two years of HEDIS® audit processes, including familiarity with supplemental clinical data, Electronic Clinical Data Systems (ECDS) reporting methodology, and experience with validating HEDIS® data sources preferred.
Experience with Medicaid or Medicare benefit programs preferred

Responsibilities

Develops and implements business and technical processes to acquire, validate, and maintain meaningful external provider data, assess and implement existing DHP vendor data opportunities, and liaise with all stakeholders to identify, optimize, and integrate HEDIS® and other performance data sources to improve Quality data reporting.
Maintains the utmost level of confidentiality at all times.
Adheres to Health System and Health Plan policies and procedures.
Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
Demonstrates a high degree of independence, flexibility, initiative, and commitment.
Leads and collaborates in the project management of complex clinical data acquisition and implementation activities. This includes coordination with internal and external stakeholders, preparedness for annual HEDIS® reporting, including HEDIS® Electronic Clinical Data Systems (ECDS) measures, and providing ongoing support to sustain the optimal results of the project.
Partners with internal stakeholders to ensure that DHP is compliant with regulatory, accreditation, and contractual requirements for HEDIS® Audit and other quality activities to maximize administrative data capture and leverage efficiencies to minimize provider administrative burden.
Develop training materials, tools and educational resources to improve stakeholder understanding and knowledge of supplemental data sources, ECDS reporting, ECDS measures and methodology, and new technologies to maximize data capture. Collaborates with internal and external stakeholders to disseminate initiatives and audit results, including providers/practice groups, and committees.
Applies analytics from the Provider Performance Platform and other internal sources to identify/target specific populations/providers to maximize quality interventions to optimize administratively captured performance data.
Facilitate identification and integration of clinical data from data aggregators, internal health plan data sources, health information exchanges (HIE) and other relevant vendor platforms to improve accuracy, completeness, and availability of electronic clinical data.
Coordinates with the Data Analytics and Data Integration teams to gather and validate data needed for modeling and analysis to support departmental and organizational quality strategies and needs.
Maintains knowledge of industry trends and standards including but not limited to National Committee for Quality Assurance (NCQA) and HEDIS® Technical specifications.
Performs other duties as requested