Quality/HEDIS Coordinator

Doctors Healthcare Plans•Coral Gables, FL

1d•Onsite

About The Position

Doctors HealthCare Plans is a Medicare Advantage health plan serving South and Central Florida. The Quality/HEDIS Coordinator supports the organization's HEDIS and CMS Star Ratings initiatives by coordinating medical record retrieval, conducting chart reviews, maintaining provider relationships, presenting performance data, and leading provider-focused quality improvement efforts. The position is the primary quality liaison for assigned provider groups and collaborates with providers, office staff, and internal stakeholders to improve HEDIS performance, close gaps in care, enhance documentation practices, and support Star Ratings performance. This is a field-based position requiring regular travel throughout Miami-Dade and Broward Counties. The role involves working independently, leading provider meetings, presenting performance data, facilitating quality improvement discussions, and building relationships with physicians and provider office staff. The coordinator manages medical record requests and retrieval through provider visits, EMR systems, secure portals, fax, or other approved methods; maintains records and tracking documentation; reviews charts for HEDIS documentation and care gaps; and supports audit readiness. The role also leads provider engagement, education, performance discussions, and follow-up on improvement plans. Additional responsibilities include maintaining tracking logs and reports, preparing presentations and meeting materials, and handling protected health information in accordance with HIPAA, CMS, AAAHC, organizational policies, and applicable regulations.

Requirements

High school diploma or equivalent.
Bilingual in English and Spanish.
At least 2 years of experience in healthcare, medical records, quality improvement, provider relations, healthcare operations, or a related healthcare environment.
Experience working with electronic medical record (EMR) systems.
Experience conducting provider outreach and professional business communications.
Strong organizational, analytical, and problem-solving skills.
Strong verbal and written communication skills.
Ability to independently lead meetings and present information to provider offices and stakeholders.
Ability to analyze performance reports and identify opportunities for improvement.
Proficiency with Microsoft Office applications, including Outlook, Word, Excel, PowerPoint, and Teams.
Ability to manage multiple priorities while meeting established deadlines.
Ability to maintain confidentiality and appropriately handle sensitive information.
Reliable transportation and ability to travel throughout Miami-Dade and Broward Counties.
Valid driver's license and reliable transportation.
Ability to conduct routine provider office visits.
Ability to transport a laptop and work materials.
Ability to sit, stand, and use a computer for extended periods.

Nice To Haves

Experience with Medicare Advantage, managed care, IPA/MSO organizations, health plans, provider network operations, or value-based care programs.
Knowledge of HEDIS and CMS Star Ratings.
Experience presenting scorecards, quality performance reports, dashboards, or operational metrics to providers or healthcare leadership.
Experience facilitating meetings and leading discussions with physicians, provider leadership, and cross-functional teams.
Experience with medical record retrieval, chart review, provider engagement, audit preparation, or healthcare quality projects.
Familiarity with medical terminology, preventive care measures, or chronic condition management.
Associate's or Bachelor's degree in Healthcare Administration, Public Health, Health Information Management, Nursing, or a related field.

Responsibilities

Contact provider offices to request medical records and coordinate onsite or remote retrieval activities.
Retrieve medical records through provider office visits, EMR systems, secure portals, fax, or other approved methods.
Upload, organize, and maintain medical records in designated company repositories and tracking systems.
Document records requested, received, reviewed, pending, and completed; monitor outstanding requests and follow up to meet deadlines.
Complete medical record collection activities in support of HEDIS and quality initiatives.
Maintain familiarity with annual HEDIS measure specifications, CMS Star Ratings requirements, and documentation standards.
Review medical records to identify documentation supporting HEDIS measures and quality initiatives.
Identify open gaps in care, missing documentation, and opportunities for performance improvement.
Validate medical record completeness and support audit readiness efforts.
Serve as the primary Quality/HEDIS point of contact for assigned provider groups.
Build and maintain working relationships with physicians, provider office leadership, clinical staff, and administrative personnel.
Schedule, coordinate, and lead quality meetings with provider groups and internal stakeholders.
Present provider scorecards, quality reports, HEDIS results, open care gaps, Star Ratings measures, and performance trends.
Facilitate discussions about performance barriers and strategies to improve measure compliance.
Educate providers on HEDIS measures, CMS Star Ratings requirements, clinical documentation standards, and annual measure updates.
Monitor provider progress toward quality goals and follow up on meeting action items.
Document meeting outcomes, recommendations, action plans, and provider commitments.
Help providers understand scorecards, gap lists, quality reports, and performance improvement opportunities.
Support provider engagement initiatives intended to improve quality performance, clinical outcomes, and CMS Star Ratings results.
Maintain HEDIS tracking logs, provider engagement records, retrieval status reports, and quality improvement documentation.
Monitor provider performance and report project status to leadership.
Validate provider contact information, office locations, HEDIS contacts, and retrieval methods.
Prepare reports, summaries, presentations, and supporting documentation for provider meetings and quality initiatives.
Maintain documentation according to organizational policies and regulatory requirements.
Maintain confidentiality of member and provider information and protect PHI during handling, storage, and transmission.
Comply with HIPAA, CMS, AAAHC, organizational policies, applicable regulations, and departmental procedures.
Travel locally throughout Miami-Dade and Broward Counties and conduct routine provider office visits.