We are seeking a highly motivated and experienced HEDIS Quality Coordinator to join our dynamic team. The HEDIS Quality Coordinator will play a pivotal role in collaborating with our Clinical Care Teams, with a primary focus on ensuring exceptional quality care for our Medicare and Medicare Advantage beneficiaries and promotion of value-based care. This individual will work closely with healthcare providers, clinical staff and administrative staff to ensure the efficient delivery, documentation and coding of quality care and chronic condition coding (HCC) in accordance with value-based healthcare principles.
Responsibilities:
- Educate Care Teams on clinical quality measures and chronic condition coding (HCC)
- Monitor and trend clinical quality measure and chronic condition coding (HCC) compliance
- Review medical charts in the EMR system for compliance with clinical quality measures and chronic condition coding (HCC) for various Medicare and Medicare Advantage quality programs
- Showcase essential skills related to strong clinical quality measure knowledge, clinical chart auditing, and clinical quality measures coding, along with chronic condition coding (HCC)
- Demonstrate advanced knowledge of Excel
- Foster a positive and supportive work environment that promotes teamwork, communication, and professional development.
- Stay informed about changes in healthcare regulations, reimbursement policies, and industry trends related to Medicare and Medicare Advantage programs.
Qualifications:
- High school diploma or equivalent, required.
- Associates required, preferred Bachelor’s degree, in a healthcare related field
- Certified/Registered Medical Assistant (current certification)-must have at least 5 years of clinical experience OR Licensed Practical Nurse (license in good standing with Florida Board of Nursing) -must have at least 3 years of clinical experience OR Registered Nurse (license in good standing with Florida Board of Nursing)-must have at least 2 years of clinical experience
- Minimum of 1 year experience in clinical quality improvement/auditing activities
- Working knowledge of ICD-10 codes and CPT codes related to clinical quality measures and chronic conditions (HCC), highly preferred
- Minimum of 2-5 years (based on certification/licensure) of experience in healthcare, with experience interacting with patients covered under Medicare and Medicare Advantage plans.
- Knowledge of Medicare and Medicare Advantage program requirements, regulations, and reimbursement policies.
- Strong, demonstrable skills in motivating and training professional staff.
- Excellent communication, interpersonal, and leadership skills.
- Proven ability to effectively manage multiple priorities and deadlines in a fast-paced environment.
- Proficiency in electronic health records (EHR) systems and healthcare billing software.
- Commitment to delivering high-quality, patient-centered care and promoting positive health outcomes.
Benefits:
- Competitive salary commensurate with experience.
- Health Insurance.
- Retirement savings plan with employer match.
- Paid time off and holidays.
- Opportunities for professional development and advancement within the organization.
If you are passionate about improving healthcare delivery and making a difference in the lives of Medicare and Medicare Advantage patients, we invite you to join our team. Please submit your resume and cover letter outlining your qualifications and interest in the position. We look forward to hearing from you!
To apply, please submit your resume and a cover letter highlighting your relevant experience and qualifications. We are an equal opportunity employer and welcome all qualified candidates to apply.
Job Type: Full-time
Pay: $21.00 - $26.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Employee discount
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Work setting:
Education:
Experience:
- eClinicalWorks: 2 years (Required)
- Primary Care Medical Office: 2 years (Required)
- Engaging with Medicare patient population: 2 years (Required)
- Clinical quality improvement/auditing activities: 1 year (Required)
- ICD-10 and CPT codes knowledge: 1 year (Required)
- HEDIS: 2 years (Required)
License/Certification:
- Nursing license (LPN or RN) (Preferred)
- Certification (Medical Assistant) (Preferred)
Work Location: In person