HEDIS Coordinator 23-01096 - Alura Workforce Solutions

Position

Coordinator - Quality Systems 

Description    

Under the direction of the Quality Systems Management Team, the Quality Systems Coordinator is responsible for completing administrative functions and supporting departmental activities including data management, research, data entry, quality control, report generation and analysis, adherence to established departmental workflows. The Quality Systems Coordinator exercises independent judgment to ensure appropriate escalation protocols when trends or deficiencies are identified.

1. 1. Perform a broad range of administrative duties, using initiative and judgment in handling confidential and time sensitive information.
2. Responsible for tracking, monitoring, and managing incoming data from physicians, audits, and internal processes supporting all HEDIS, Risk Adjustment and Quality activities.
3. Perform research, data entry and quality control on key data sources following prescribed guidelines/protocols in support of regulatory reporting requirements including: HEDIS, Risk Adjustment and Quality activities.
4. Adherence to established departmental workflow protocol in areas, as assigned.
5. Generate standardized reports in support of departmental activities.
6. Exercise independent judgment and discretion in such tasks as scheduling appointments and answering telephone calls.
7. Establish and maintain effective working relationships with others throughout the organization.
8. Demonstrate a commitment to incorporate LEAN principles into daily work.
9. Any other duties as required to ensure the Health Plan operations are successful.
10. Ensure the privacy and security of PHI (Protected Health Information) as outlined in the companies policies and procedures relating to HIPAA compliance.
11. Quality Management responsibilities include:
        a. Provide administrative support to the Quality Management Nurses, including scheduling appointments, requesting medical records or other documentation, research provider metrics, ensure complete and accurate data entry of facility site review and medical record review data.
        b. Track and enter key data elements to support Potential Quality Incidents (PQIs), support nurse directives to request and compile case documentation, ensure complete and accurate data entry and case documentation is maintained within the QM database, following departmental protocols.
        c. Provide administrative support to Corrective Action Plan (CAP) follow up activities, including drafting of letters, monitoring CAP timeframes and completion of CAP activities through case closure.
        d. Generate, review, and escalate, as needed, weekly aging report to ensure compliance to regulatory case timeframes.
12. Quality Assurance responsibilities include:
        a. Support the development and testing of audit tools, including the creation of data dictionaries
        b. Use of audit tools to audit departmental activities
        c. Policy review support activities, including road mapping and redlining departmental policies
        d. Provide administrative support Credentialing and Peer Review Committee reports and memos. These activities include gathering provider profile reports.
13. HEDIS responsibilities include:
        a. Coordinate HEDIS Improvement meetings, including agenda meeting, packets, and minutes.
        b. Provide timely and accurate monitoring of all incoming tasks from Member Services, Care Management teams. Research and respond to issues timely.
        c. Responsible for supporting the companies supplement database needs including data entry, research, quality assurance and reporting.
14. Specific Risk Adjustment responsibilities include:
        a. Provide timely feedback and education on inquiries into the Medicare team to both physician offices and internal team members.
        b. Perform outbound Member calls based on inquiries submitted by our Home Assessment vendor(s) by working collaboratively with Member Services, Provider Services and Medical Services staff.
        c. Answer all HCC-related calls and facilitate the answering of questions that come into the Medicare team phone line.

• Three or more (3+) years of administrative experience in an office environment, including use of Microsoft Office Suite. Demonstrate superior interpersonal and administrative skills commensurate with years of experience.
• High school diploma or GED required.
• Associate degree from an accredited institution preferred.
• Yes, must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on insurance standards of no more than three (3) points.
• Ability to multi-task to coordinate, prepare and monitor special projects and reports as required