HEDIS/STARs Specialist

The Quality Management department is seeking a HEDIS/STARs Specialist to assist with all levels of provider engagement in performance programs. This is a position that may include field work in the future to train staff and providers as well as perform chart abstracts.

Duties and Responsibilities

1. Responsible for educating providers and their staff on HEDIS and STARs measures.

2. Recommend workflow efficiencies to providers and their staff in an effort to improve HEDIS scores.

3. Train providers and staff on health plan P4P incentive programs, track progress and make recommendations for success

4. Identify member service gaps and review reports with providers and their staff.

5. Collects medical records and reports from provider offices based on open member care gaps.

6. Works directly with other MedPOINT HEDIS/STARs specialists as well as health plan staff to monitor gap closures and improvement activities.

7. Active participates in scheduled meetings with MedPOINT QM Specialist team and health plan JOMs.

8. Handle incoming calls from providers and provider staff to answer questions regarding quality metrics

9. Coordinate quality initiative projects for various groups and perform follow up and outcome determination.

10. Trains offices in enterprise wide HEDIS software program (Cozeva) and track usage.

11. Assist with member outreach efforts as directed.

12. Submit actionable work plans to health plans and track progress.

13. Supplemental data submission and tracking.

14. Participate in supplemental data overreading as needed.

15. Create and present provider training materials to individuals as well as in small and large group settings.

16. Additional QM tasks as directed.

Minimum Job Requirements

· High school graduate or GED equivalent

· Minimum of four years’ experience working in a quality department in health plan or IPA HEDIS environment

· Working knowledge of NCQA HEDIS technical specifications.

· Current CA driver’s license.

· Willing to travel to provider offices throughout Los Angeles

Skill and Abilities

· Effective verbal and written communication skills

· Excellent interpersonal skills

· Ability to multitask in a busy department.

· Innovative critical thinker.

· Ability to work independently and productively in remote setting.

· Able to manipulate and analyze large files and data sets.

· Excellent project management and organizational skills

· Intermediate to advanced skills with Microsoft Office Products (particularly with Word and Excel).

· EZ-CAP® knowledge a plus