Implementing Healthcare Effectiveness Data and Information Set (HEDIS) project plan and meets all requirements of National Committee for Quality Assurance (NCQA) and regulatory, which includes project monitoring, data collection, quality control, and reporting. Applying both business knowledge and technical expertise to supports HEDIS strategies, goals, and initiatives at corporate and plan-level.
Principle Accountabilities include but are not limited to:
• In collaboration with the HEDIS manager to develop annual HEDIS project plans and monitor the HEDIS project plans for multiple LOBs
• Prepare HEDIS onsite audit
• Facilitates the relationship with Medical Record Review vendor
• Represent HEDIS team in collaboration with internal departments for HEDIS improvement
• Prepare HEDIS Road Map and all other documents required by auditors.
• Ensures all data sent to HEDIS software vendor are accurate and meet HEDIS reporting timeline.
• Ensures all HEDIS supplemental data sources are gathered and are completed
• Improves HEDIS reporting process by leading a “lessons learned” process for internal operational improvement
• Other duties as required and/or assigned
Education & Experience:
• Bachelor’s Degree required
• Minimum 3 years working experience in the health care industry.
• Minimum 1 year of Project Management and HEDIS knowledge required.
• Extensive knowledge of Microsoft Office.
Other Skills:
• Ability to manage multiple, complex projects with strict deadlines.
• Excellent verbal and written communication skills.
• Strong desire for accuracy, a concern for detail.
• Strong SQL/SAS programming skills preferred.