HEDIS Specialist

Spectraforce Technologies

United States, North Carolina, Raleigh

500 West Peace Street (Show on map)

Oct 24, 2024

Title: HEDIS Specialist

Duration: 6 Months (Potential to extend)

Location: Remote - Nationally Sourced

Responsibilities:

* Develop and implement innovative strategies in collaboration with clinical staff to improve compliance with key behavioral health HEDIS metrics and Pay for Performance (P4P) Measures

* Prepare and present financial impact and return on investment on initiatives requiring additional funding or resources

* Act as a liasion with quality improvement, health plan medical management and other departments regarding current and planned interventions, collect input on how to impact these outcomes, and provide feedback to stakeholders on outcomes

* Monitor the effectiveness for new and existing P4P and HEDIS initiatives and ensure appropriate knowledge/education and interventions are conducted for members falling into these measures

* Analyze data to address trends or potential quality and clinical improvement opportunities based on best practices and feedback from involved stakeholders

Responsibilities include retrieving medical records with clinical accuracy using remote access to Electronic Medical Record Systems while meeting daily productivity expectations. Accuracy and productivity rates are closely monitored to maintain a >95% accuracy rate, but also to be efficient and productive as compared to their peers. Additionally, perform RateMax duties including, but not limited to, medical record review for missed opportunities and provider chase leads, claims research, and chase activation.

Complete training and testing in the required timeframe with a satisfactory pass rate.
Communicate and collaborate with coworkers, team leads and manager.
Follow HIPAA and company guidelines to safeguard PHI and PII
Utilize company equipment in a private, secured, at home location using wired cable, fiber, DSL or BPL internet.
Additional tasks as delegated by team leads and/or manager.

Internal/External Groups with which the Candidate will interface:	Centene Corporate HEDIS Clinical Operations
Required Skills/Experience:		Preferred Skills/ Experience:
1.	Electronic Medical Record (EMR) navigation	1.	HEDIS Project experience
2.	Ability to be productive independently in a remote environment	2.	Experience abstracting data from medical records
3.	Healthcare experience in medical terminology, medical record review, coding, or similar experience	3.	Experience in QSHR or working with copy service vendors
4.	HEDIS knowledge	4.	Ability to adapt to changing priorities in managing a wide range of projects.
5.	Attention to detail	5.	Remote Access EMR record retrieval
Education Requirement:	Associate's degree or relevant 2+ years' medical and HEDIS experience	Education Preferred:	Associate's degree RN or LPN