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JOB DESCRIPTION

JOB TITLE: HEDIS®/Stars Coordinator I FLSA STATUS: Non-Exempt

DEPARTMENT: Quality & Risk Adjustment

REPORTS TO: Quality Programs Manager, Imperial Health Plan

JOB SUMMARY: Under direct supervision of Quality Programs Manager, this position is responsible for helping to ensure Imperial Health Plan maintains compliance with regulatory requirements and quality standards associated with the NCQA Healthcare Effectiveness Data and Information Set (HEDIS®) and CMS Stars programs. This will be accomplished by observing a high degree of organization and attention to detail, effective communication, and the ability to work collaboratively with QI teams, other internal departments, as well as external provider contacts to manage competing priorities successfully. .

ESSENTIAL JOB FUNCTIONS:

1. HEDIS® Data Collection: Assists with the collection, validation, and submission of HEDIS® data (clinical record pdfs and supplemental files) in accordance with NCQA guidelines and timelines. Also assists with resolving requests for assistance from data collection vendors.

1. Quality Assurance: Ensures the accuracy and completeness of tasks assigned directly and ensures standards utilized for the naming, layout, saving, and logging of files are observed by the team.

1. Compliance: Helps ensure quality improvement (QI) activities meet up to date HEDIS® and Stars regulatory requirements by highlighting annual updates to annually published updates to performance measure specifications, submission processes, and timelines.

1. Documentation: Maintains detailed and accurate logs of year-round and audit season activities, especially as they pertain to HEDIS® data collection and validation, and as reflected by statements in Imperial Health’s annual HEDIS® ROADMAP workbooks.

1. Data Analysis Support: As part of Quality Assurance, helps ensure minimum criteria standards are met for outgoing reports from Imperial Health, and incoming supplemental data and manifest to Imperial Health when assigned.

1. Reporting: Assist with proofing materials from QI management to Imperial Health Leadership, provider partners, and/or external stakeholders when assigned.

1. Training and Support: Help maintain and update training materials for internal and external stakeholders, especially on HEDIS® measures, data collection procedures, and compliance requirements.

1. Process Improvement: As part of Documentation and Data Analysis Support, highlight and share findings and suggestions to improve efficiency and accuracy related to inter-departmental coordination as well as documentation and filing practices.

1. Collaboration: Work closely with healthcare providers and other QI teams when needed to ensure the timely completion of assigned tasks as well as seamless HEDIS® data collection and submissions.

1. Coordination: Works closely, as necessary, with all parties described in this list to ensure the timely completion of tasks as directed and/or per timelines set forth by audit specifications.

1. Assists management with other duties as assigned.

1. Adheres to payroll policies and properly uses a time-keeping system with minimal manual changes.

1. Maintains regular and consistent attendance.

1. Adheres to Compliance Plan and HIPAA regulations.
   

MARGINAL JOB FUNCTIONS:

BEHAVIORAL EXPECTATIONS:

1. Continuous Learning:

a. Attends staff meetings as required.

b. Attends appropriate training, seminars and workshops as required

2. Customer Focus:

a. Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations

and IMAS’s Standards of Conduct.

b. Fosters appropriate communication and relations with Manager, Supervisor, co-workers, and other staff.

3. Quality/Process Improvement/Safety

a. Reports issues of security, health and/or safety to appropriate manager as soon as practicable.

b. Supports and demonstrates safety throughout all duties performed.

c. Follows established policies and procedures and understands and complies with all regulators

standards set forth by governing entities.

POSITION REQUIREMENTS:

EDUCATION/EXPERIENCE:

• High school graduate or GED equivalent
• Working knowledge of Microsoft Excel and/or managing tasks lists, and tracking progress

PREFERRED:

• 2-3 years’ experience supporting HEDIS®, AMP, or other performance programs
• or at least 3 years’ experience working in an IPA/MSO/Health plan or general healthcare quality environment

SKILLS/KNOWLEDGE/ABILITY:

LICENSURE/CERTIFICATE/TRAINING: