Quality HEDIS Coordinator

Doctors Healthcare Plans•Miami, FL

About The Position

Doctors HealthCare Plans is a Medicare Advantage health plan serving South and Central Florida. The Quality HEDIS Coordinator supports HEDIS and CMS Star Ratings initiatives through medical record retrieval, chart reviews, provider engagement, performance reporting, and provider-focused quality improvement. The position serves as the primary quality liaison for assigned provider groups, collaborating with physicians, 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 role requiring regular travel throughout Miami-Dade and Broward Counties. The coordinator works independently, leads provider meetings, presents performance data, facilitates quality improvement discussions, and builds relationships with physicians and provider office staff. The role also maintains tracking and reporting documentation and ensures compliance with confidentiality, 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 Outlook, Word, Excel, PowerPoint, and Teams.
Ability to manage multiple priorities and meet established deadlines.
Ability to maintain confidentiality and handle sensitive information appropriately.
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, transport a laptop and work materials, and 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.
Retrieve medical records through provider visits, EMR systems, secure portals, fax, or other approved methods.
Upload, organize, and maintain medical records in company repositories and tracking systems.
Document records requested, received, reviewed, pending, and completed, and follow up on outstanding requests to meet project 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 care gaps, missing documentation, and opportunities for performance improvement.
Help validate medical record completeness and support audit readiness.
Serve as the primary Quality/HEDIS contact for assigned provider groups 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.
Help 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 materials for provider meetings and quality initiatives.
Maintain documentation according to organizational policies and regulatory requirements.
Protect confidential member and provider information and properly handle, store, and transmit protected health information.
Comply with HIPAA, CMS, AAAHC, organizational policies, applicable regulations, and departmental procedures.