Every position with MedPOINT management contributes to a higher purpose – to help sustain accessible, affordable, quality care in the beautiful and diverse communities we serve.
HEDIS/STARs Specialist
Summary
The Quality Management department is seeking a HEDIS/STARs Specialist to assist with provider engagement in the provider performance programs.
This is currently a remote position but may include field work to train staff and providers as well as performing chart abstracts.
Duties and Responsibilities
Responsible for educating clinics/providers and their staff on HEDIS and STARs measures Recommend workflow efficiencies to clinics/providers and their staff in an effort to improve HEDIS scores Train clinics/providers and staff on health plan P4P incentive programs and track progress and make recommendations for success Identifies member service gaps and reviews reports with clinics/providers and their staff Collects medical records and reports from clinics/provider offices based on member needed services reports and gaps Works directly with other HEDIS/STARs specialists at MedPOINT as well as health plan staff to monitor the gap closures and improvement activities Work within established guidelines, apply technical knowledge in collaboration with multiple departments to solve complex issues that may have long-term impact on the quality scores Partner with health plans and internal departments to identify potential areas of focus for new programs, soliciting ideas across a variety of stakeholders, transforming those ideas into initiatives, and supporting the implementation and adoption of those new initiatives Assists the QM staff with clinic/physician and member interventions and incentive efforts as applicable Participates in scheduled meetings with the MedPOINT QM Specialist team and vendors Trains offices in enterprise wide HEDIS software program and track usage Assist with member outreach efforts as directed Submit actionable work plans to health plans and track progress Supplemental data submission and tracking Create and present provider training materials Prepare monthly reporting for Board meetings and present information when requested at the meetings Additional QM tasks as directed
Minimum Qualifications:
High school graduate or GED equivalent; BA or BS preferred Minimum of four years’ experience working in a quality department in health plan or MSO/IPA HEDIS environment Working knowledge of NCQA HEDIS measure requirements Willing to occasionally travel to clinics/provider offices in Los Angeles area
Knowledge, Skills and Abilities Required:
Effective verbal and written communication skills Good interpersonal skills Ability to multitask in a busy department Able to work with large files and data sets Strong ability for audience engagement Excellent project management and organizational skills Able to work well remotely in independent environment Microsoft Office skilled (particularly with Word,Excel and Power Point)