Hedis Medical Assistant Specialist

Website La Maestra Family Health Center


Paid Holidays, 401K / Retirement Plan, Health Insurance

Job Description

Job Title:        HEDISMedical Assistant Specialist

Reports To:    Patient Care Director

Job Status:     Non-Exempt


As a Healthcare Effectiveness Data and Information Set (HEDIS) Specialist/Administration Assistant, this position performs duties that emphasize quality of care, patient safety and customer service. The HEDIS Specialist is responsible for ensuring that all La Maestra Community Health Center patients, assigned to the clinic by the health plans, are scheduled for appropriate appointments addressing any HEDIS gaps, according to the National Committee for Quality Assurance (NCQA) HEDIS guidelines. They are to ensure that all patients are scheduled for the correct visits, within the required timeframe, depending on their HEDIS care gaps and conduct follow up calls and reminders until the patient is scheduled and seen. The HEDIS Specialist must work in collaboration with the patients Care Team and other clinical staff to ensure coordinated care and proper appointment scheduling.

Responsibilities of HEDIS Specialist

  • Performs electronic health record reviews, abstractions and data entry for HEDIS measures
  • Reviews assigned medical records in order to abstract clinical data elements for HEDIS reporting, e.g., results of laboratory tests, verification of hypertension and the most recent blood pressure reading, prenatal and postpartum care services
  • Integrates data collected from a variety of electronic and paper sources
  • Identifies findings supported by documentation guidelines with high level of accuracy
  • Case manage all health plans’ HEDIS patients utilizing the SSRS SharePoint and reporting tool
  • Compare internal HEDIS data with health plan data to ensure there are no data gaps
  • Ensure all patients are scheduled for their HEDIS gaps and attend their visits, or do follow up calls and reminders until the patient is scheduled and seen
  • Check patient eligibility prior to calling and scheduling the patient for a visit to ensure the patient is still eligible with that insurance
  • Work with billing to make sure that all visits are processed properly and all HEDIS codes are pushed out to the health plan
  • Work with health plans when needed to ensure proof of visits and services are captured
  • Provide daily call logs to manager at the end of each day
  • Check department voicemail messages and take suitable action (i.e. call back patient, schedule appointment, forwarding message information to intended recipient, etc.)
  • All voicemails are expected to be checked daily
  • Working to improve annual HEDIS scorecards from all health plans
  • Maintain effective communication and working relationships with other employees and patients
  • Other duties as assigned

Additional Duties and Responsibilities

  1. Attend staff meetings
  2. Performs other duties as assigned.
  3. Remain familiar and up to date with all policies, procedures, and protocols pertaining to HEDIS

Responsibilities of a Medical Assistant

  • Move patient from waiting room to examination room in a timely manner
  • Take vital signs, height and weight. Must be documented in patient chart and in i2i tracks.
  • Prepares patient for examination
  • Prepares needed equipment and supplies in exam room for physicians. Check exam room for cleanliness
  • Administers and charts treatments, procedures and injections
  • Assists physicians with examinations
  • Translate between doctor and patient by explaining diets, treatments or special instructions to be followed by the patient. Translate only what provider says, unless instructed otherwise.
  • Gathers correct lab and x-ray results for each patient
  • Collects non-blood specimens such as urine, sputum, and throat swabs for laboratory testing and logs specimen as directed. Ensures specimen requirements are met at the time of collection. (Depending on specialty)
  • Performs skillfully in an emergency situation, preparing IV for administration, being knowledgeable of contents of crash cart and emergency protocol of clinic, able to initiate CPR. (Depending on specialty)
  • Administers medication by mouth, as instructed by the physician
  • Performs treatments as ordered by provider and supervised by RN
  • Clean specialty areas to provide back-up coverage and assist as necessary. Be knowledgeable of specialty services, instruments, supplies and equipment
  • Remove all contaminated items in rooms before leaving the room.
  • Soak instruments as needed in special solutions. (Depending on specialty)
  • Obtains consent before minor surgical procedures
  • Call all no-show patients on a daily basis (the day the appointment was missed). Document the dates and times called in the patient’s chart
  • Prepare and send out follow up letters on a daily basis
  • Maintain effective communication and working relationships with other employees and patients

Patient Centered Medical Home Essential Responsibilities (Principals)

·        Collaborate with individual patients, their personal physicians, and when appropriate the patient’s family to ensure accessible, comprehensive, compassionate, and culturally competent care

  • Facilitate care by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

·        Ensure all decisions respect patients’ wants, needs, and preferences and that patients have the education and support they require to make decisions and participate in their own care.

·        Continually strive to attend to each patient “whole person,” in the context of the patient’s personal and medical history and life circumstances, rather than focusing on a particular disease, organ, or system

Job Requirements

Education: High School Diploma, GED, or equivalent, Medical Assistant Certificate, CPR certification

Experience: 1-2 years of experience in physician office, health plan or hospital setting preferred.

Verbal and Written Skills to perform the job: Bilingual preferred. Familiarity with basic word processing, spreadsheet, and database applications. Accurate keyboarding skills.

Technical knowledge and skills required to perform the job: Excellent verbal, written and interpersonal communication skills and the demonstrated ability to work with diverse individuals and groups. Demonstrate high levels of self-initiation and direction. Knowledge of communities we serve. Knowledge and experience working in medical settings and interacting collaboratively with medical teams. Skill in analyzing situations and making timely decisions.

Physical and Mental Requirements: Work involves sitting, talking, hearing, using hands to handle, feel or operate objects, tools, or controls, and reaching with hands and arms. The employee may be required to push, pull, lift, and/or carry up to 20 pounds. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

La Maestra Community Health Centers is an Equal Opportunity Employer. We encourage applications from all individuals regardless of race, religion, color, sex, pregnancy, national origin, sexual orientation, ancestry, age, marital status, physical or mental disability or any other protected class, political affiliation or belief.

To apply for this job please visit lmfc.quickbase.com.