HEDIS Specialist-Bilingual Spanish - Anaheim HC, CA-ANA

Planned Parenthood of Orange and San Bernardino Counties has a full-time opportunity for a HEDIS Specialist-Bilingual Spanish  in Anaheim, CA.

The HEDIS Specialist is responsible for managing the HEDIS reporting process for Planned Parenthood Orange and San Bernardino Counties. This role involves working closely with various plans to ensure accurate and timely data collection, validation, and reporting for HEDIS measures. Provide feedback to management via Tableau dashboards, Microsoft Excel spreadsheets, and PowerPoint presentations.

At PPOSBC, we understand the importance of a well-rounded benefits program and are dedicated to providing you with unique benefits that meet the needs of you and your family. We are proud to offer a range of plans that help protect you in the case of illness or injury including:

• A competitive benefits package including medical, dental, and vision coverage for you and eligible dependents, life insurance, and long term disability. 
• Benefits coverage starts after one full month of employment!
• Generous vacation, sick, and holiday benefits!
• Generous 401(k) matching contributions and more!
• To view our detailed benefits guide, please visit our career site at www.pposbccareers.org

Responsibilities

 Essential functions encompass the required tasks, duties and responsibilities performed as part of the job and the reason the job exists. 

• Responsible for contacting plans and payers to retrieve documents and/or utilize provider portals that confirm quality measures, analyze and process the information collected.
• Effective communication and interpersonal skills, with the ability to collaborate across PPOSBC internal teams, contracted plans and payers to optimize financial outcomes while maintaining high-quality patient care.
• Participates in meetings with contracted plans and payers for the HEDIS and Pay for Performance data collection process
• Cultivate positive relationships with payers and serve as one of the points of contact for HEDIS related inquiries from contracted plans and payers in order to communicate program details, expectations, and performance feedback.
• Ability to plan, organize, coordinate, interpret and prepare results of quality improvement- HEDIS/Pay for Performance loading data into Microsoft Office (Word, Excel, and PowerPoint) with minimal entry errors
• Generate reports and dashboards to track key performance indicators, identify higher weighted and bundled measures.
• Prepare reports to present to leadership on program performance, financial outcomes and quality metrics.
• Thoroughly, accurately and timely collect and data enter clinical information from payers and Health Plans into a database in accordance with HEDIS and Pay for Performance (i.e., childhood immunizations, diabetic laboratory data, asthma medication)
• Provide regular updates and reports on HEDIS performance from plans and payers
• Support reporting incentive data tied to Pay for Performance metrics
• Assist Director with special HEDIS and Pay for Performance duties/projects
• Perform a broad range of administrative duties using initiative and judgment in handling confidential and time sensitive information
• Assists with answering and transferring calls
• Assists patients with primary care switches, enrollment questions and educates patients on primary care services offered at Melody Health
• Walk patients through Melody enrollment process
• Educate patients on the importance of health care coverage and answer questions pertaining to the health care system as it relates to enrollment. 

Non-Essential Functions:

• Other duties as assigned. 

PHYSICAL REQUIREMENTS:

The physical requirements of this position are identified below.  Reasonable accommodations may be made for individuals with disabilities to perform the essential functions of this position.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Education:

• High School Diploma or GED equivalent required.
• Associates Degree Preferred 

Minimum Work Experience:

• Knowledge and understanding of HIPAA and PHI regulations required
• Knowledge of HEDIS, Pay for Value, and NCQA/CAHPS
• 2-3 years of experience in HEDIS reporting within a healthcare organization.
• Strong understanding of HEDIS measures, specifications, and reporting requirements
• Excellent analytical skills with the ability to interpret and analyze complete healthcare data
• Computer literate with Microsoft Office (Word, Excel, and PowerPoint). 

Agency Standard Requirements:

• Strong commitment to quality healthcare and excellent customer service is required.
• Must thrive in a fast-paced, rigorous environment with changing priorities.
• Ability to meet deadlines and work under pressure.
• Must demonstrate high-level computer skills including Microsoft Word, Excel, and Outlook. Electronic medical records experience may also be required.
• This position requires travel to other sites and locations; if using a personal vehicle to meet this requirement, a valid CA driver’s license and current auto insurance in compliance with the minimum requirements of CA vehicle code are required.
• Abortion patients are cared for at each of our health centers and in part through the administrative, support, and other non-clinical services provided at all PPOSBC locations and by all PPOSBC employees, and supporting these critical services is an essential job duty and fundamental responsibility of all employees. 

Other Requirements:

• Work well with diverse communities that are uninsured/underinsured
• Understanding of Health Care Reform and Covered California Exchange Market preferred
• Overall excellent people and customer service skills
• Ability to build on and leverage existing resources within the organization
• Ability to work effectively and efficiently in a fast-paced environment
• Ability to motivate others and work collaboratively with team members
• Ability to stay up to date with current changes in healthcare
• Must be able to work independently, be self-motivated, and demonstrate high attention to detail