HEDIS Specialist

Website La Maestra Family Health Center

Reports To: Quality Improvement

Job Status: Non-Exempt

Status/ Hours: Full Time

Summary

As a Healthcare Effectiveness Data and Information Set (HEDIS) Specialist, 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

  • 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

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 patients’ “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

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

 

Quality Management

  1. Display knowledge of normal signs of human development and ability to assess and provide age appropriate care.
  2. Contribute to the success of the organization by participating in quality improvement activities

Customer Relations

  1. Respond promptly and with caring actions to patients and employees.  Acknowledge psychosocial, spiritual and cultural beliefs and honor these beliefs.
  2. Maintain professional working relationships with all levels of staff, clients and the public.
  3. Be part of a team and cooperate in accomplishing department goals and objectives
  4. Interacts and communicates in a manner to reflect an understanding of the patient’s age, culture, state of health, and level of comprehension

Safety

  1. Maintain current knowledge of policies and procedures as they relate to safe work practices.
  2. Follow all safety procedures and report unsafe conditions.
  3. Use appropriate body mechanics to ensure an injury free environment.
  4. Be familiar with location of nearest fire extinguisher and emergency exits.
  5. Follow all infection control procedures including blood-borne pathogen protocols

HIPAA/Compliance

  1. Maintain privacy of all patient, employee and volunteer information and access such information only on a need to know basis for business purposes.
  2. Comply with all regulations regarding corporate integrity and security obligations. Report unethical, fraudulent or unlawful behavior or activity.

Work Environment

  1. The noise level in the work environment is usually moderate
  1. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Interested Applicants please submit Cover Letter and resume to:
Human Resources Department
Email: employment@lamaestra.org | Fax: 619-269-1291

La Maestra Community Health Centers is an equal opportunity employer and does not
discriminate on the basis of race, religion, color, sex, national origin, age, sexual orientation, gender, disability or any other legally protected status.

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