What are the responsibilities and job description for the HEDIS Specialist position at TotalMed Medfi?
Pay: $25.00 per hour
Hours: Monday-Friday 8 am-5 pm
Location: Remote in KY
Position Purpose: Serves to collaborate with providers, to improve HEDIS measures and provides education for HEDIS measures and coding. Team members will be making outreach calls to members to educate regarding plan benefits and care gaps, assisting with warm transfers to provider offices to schedule appointments as needed, and assisting members in other ways that are beneficial to the member.
Responsibilities:
- Advises and educates Provider practices in appropriate HEDIS measures, and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements.
- Assesses provider performance data to identify and strategizes opportunities for provider improvement.
- Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations (claims and encounters).
- Schedules doctor appointments for members with care gaps to access needed preventive care services and close gaps in care in the provider’s office.
- Conducts face-to-face education with the member and their family, in the provider’s office, about care gaps identified, and barriers to care.
- Conducts telephonic outreach and health coaching to members to support quality improvement, regulatory and contractual requirements.
- Arranges transportation for members as needed.
- Arranges follow-up appointments for member as needed.
- Documents all actions taken regarding contact related to member.
- Interacts with other departments including customer service to resolve member issues.
- Refers to case or disease management as appropriate.
- Completes special assignments and projects instrumental to the function of the department.
- Performs other duties as assigned.
- Position may be located in a provider's office
Requirements:
2 years of HEDIS Experience
2 years of Quality Improvement Experience
4 years of Direct Patient Care, Social work, Quality improvement or Health coaching Experience
Bachelor Degree
Licensed Practical Nurse (LPN); Licensed Master Social Work (LMSW); Certified Social Worker (C-SW); Licensed Social Worker (LSW) Preferred
#INDQI
Job Type: Full-time
Pay: $25.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Work setting:
- Remote
Application Question(s):
- Which city do you live in or closest to (Kansas City, Springfield, or St. Louis - MO)?
Education:
- Associate (Required)
Experience:
- HEDIS: 2 years (Required)
- Quality improvement: 2 years (Required)
- Direct Patient Care, Social work, or Health coaching: 4 years (Required)
License/Certification:
- LPN, LMSW, C-SW, or LSW (Preferred)
Work Location: Remote
Salary : $25 - $0
