Coordinator, HEDIS & NCQA

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

What You Will Be Doing:

This position is responsible for coordinating the HEDIS and NCQA activities for HPSJ and ensuring that key activities are completed in a timely manner. Collaborate with internal areas across the company, to ensure all accreditation requirements are met through continual review, audit, and monitoring of accreditation requirements. Coordinate the completion and maintenance of all accreditation reporting, documentation, readiness assessment audits, and policies, procedures, and audit tools. Work is varied and moderately complex and requires a minimal to moderate degree of discretion and independent judgment.

Eligible for remote work.

Our Vision:

Continuously improve the health of our community.

Our Mission:

We provide healthcare value and advance wellness through community partnerships.

Essential Functions:

• Collaborates with QI team and leadership to assist in identifying quality issues and root causes and helps to coordinate interventions plans.
• Works with internal to HPSJ, i.e., Quality team members, network management, case management, member services teams, etc., as well as external, i.e., provider/designated group contacts) in the evaluation, communication/outreach and support of non-compliant members, providers, and groups.
• Coordinates the timely distribution, completion, and submission of approved related documents to auditors for NCQA and HEDIS as aligned with HPSJ calendar for both activities.
• Retrieves and manages medical record requests in compliance with HIPAA and HPSJ policy/procedure.
• Schedules educational sessions for medical groups and physicians on issues identified during QI and/or HEDIS processes.
• Compiles and updates the annual HEDIS and NCQA measures matrix and providers quarterly updates to department heads.
• Assists with implementation of HEDIS project plan based on established guidelines and submits for approval.
• Monitors project progress and timelines; escalates issues to supervisor as necessary.
• Prepares HEDIS roadmap in collaboration with HEDIS staff and relevant department heads; makes recommendations for chase logic; submits for approval.
• Schedules QM staff for medical record review and data abstraction.
• Coordinates HEDIS medical record review with internal and external staff.
• Primary point of contact for HEDIS/NCQA vendor related to data runs, chase logic, system issues and submission of data and reports.
• Conducts medical record review on immunization data abstraction, aggregation, and analysis.
• Assists with the preparation and rollout of HEDIS education and training for staff and network providers.
• Compiles various internal and external reports; obtains approval and distributes as necessary.
• Works with internal and external stakeholders to collect documents and reports and complete required member/ surveys in a timely manner.
• Ensures that reports are analyzed and reported by responsible entities in a timely manner and in accordance with the NCQA activities calendar.
  
  

What You Bring:

Knowledge, Skills, Abilities and Competencies

• Required
• Produces work that is accurate and complete.
• Produces the appropriate amount of work.
• Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
• Rebounds from setbacks and adversity when facing difficult situations.
• Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
• Strong knowledge of HEDIS program processes, including measures and processes.
• Strong knowledge of NCQA accreditation process or other accreditation process.
• Basic knowledge of quality management principles and practices.
• Basic knowledge of medical record abstraction and review, with the ability to conduct simple medical record reviews.
• Basic knowledge of the healthcare and managed care industry, its products, services, and major business processes.
• Ability to read, interpret and apply moderately complex written guidelines, instructions, and other materials.
• Ability to gather and compile data and information and perform simple analysis.
• Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
• Strong oral and written communication skills, including the ability to communicate professionally and effectively with individuals and groups inside and outside of HPSJ.
• Basic project planning skills.
• Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
• Strong facilitation, problem solving and conflict resolution skills, with the ability to use tact and diplomacy to diffuse emotional situations.
• Strong customer service skills.
• Strong collaboration skills.
• Ability to work independently and as part of a team.
• Basic arithmetic skills.
• Intermediate Windows and Word skills; advanced Excel skills.
• Type 50 WPM at 90%.
• Ability to speak and be understood in English.
• Ability to handle confidential information with appropriate discretion.
  
  

What You Have:

Education and Experience

Required

• High school diploma.
• At least two years experience coordinating the HEDIS process/NCQA accreditation or other.
• At least three years experience as an administrative assistant in a healthcare setting; OR.
• Equivalent combination of education and experience.
  
  

Preferred

• Managed care or quality experience strongly preferred.
  
  

Licenses, Certifications

Required

• None
  
  

HPSJ Perks:

What You Will Get:

• Competitive salary
• Robust and affordable health/dental/vision with choices in providers
• Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
• CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
• Two flexible spending accounts (FSAs)
• Employer-Paid Term Life and AD&D Insurance
• Employer-Paid Disability Insurance
• Employer-Paid Life Assistance Program
• Health Advocacy
• Supplemental medical, legal, identity theft protection
• Access to exclusive discount mall
• Education and training reimbursement in addition to employer-paid elective learning courses.
• A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
• A shorter commute ­– if you’re commuting from the Central Valley to the Bay Area.
• Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.
  
  

We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics, or is associated with anyone who has or is perceived to have these characteristics.

Important Notice : This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.