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Minimum 10 years experience in quality compliance/HEDIS operations, customer service or provider service in a managed care setting with previous leadership experience to include managing people, project management, team building, and experience developing performance measures that support business objectives.
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Responsible for partnering with MHI RQES and VP Stars in developing the local Medicare Stars work plan and executes on interventions that will improve CAHPS, HEDIS and HOS scores. Supports MHI HEDIS Operations to do majority of HEDIS abstractions.
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Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. 3+ years of experience in HEDIS record collection and risk adjustment (coding.
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The Clinical Practice Coach & Oversight, ECM, RN is responsible for staying up do date with ECM Model of Care, DHCS, NCQA and HEDIS measures. Help educate ECM care teams of most appropriate decision in managing patients’ conditions and navigating the complexities of a multidisciplinary care team.
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Ensures compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment and HEDIS measures Consults with the Sr. Manager of Quality and Risk Adjustment and other stakeholders on the development of goals and standards that align with the strategic plan of SHCN. Provides expertise to develop and sustain process improvements at all levels of the organization.
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The organization exceeds the 90th percentile in most HEDIS measures, is among the top provider groups nationally in patient experience and provides care at a cost well below market competitors.
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Working knowledge of lnterQual IS-SI, Milliman and Robertson Managed Care Guidelines, Erickson Life Skills (Age Competencies}, Medicare Part A and Part B, Medi-Cal, NCQA,HEDIS and other criteria as identified by the Quality/Case Management Department.
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The Care Coordinator will be Trilogy’s clinic al liaiso n to managed care organizations (MCOs) , Integrated Health Homes (IHH), The Illinois Health Practice Alliance (IHPA) , and will ensure compliance with The Healthcare Effectiveness Data and Information Set ( HEDIS ) measures.
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Utilizes extensive HEDIS and coding knowledge, combined with medical policy, credentialing, and contracting rules knowledge to help build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality outcomes and STARs outcomes while not compromising payment integrity.
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Ensure accurate documentation in the electronic health record (EHR) and electronic medical record (EMR) systems, including documentation of HEDIS and Stars quality measures. Experience with HEDIS and ICD/CPT coding.
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The role assists contracted providers with analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using approved clinical practice guidelines, HEDIS, CMS, NCQA and other tools.
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Demonstrated knowledge of Hedis and QARR quality measures, ICD- 10 and CPT coding for reimbursement of services , required. Manages and provides clinical services in compliance with standards of Patient -Centered Medical Home standards, meaningful use of medical record data, HEDIS and QARR quality of care measurements.
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Epic Clarity Reports Developer and Analyst (P4P, QIP, HEDIS) (Hybrid, San Jose, CA) We are looking for an Epic Clarity Reports Developer and Analyst (P4P, QIP, HEDIS) for our client, a County in the State of California.
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Manages and oversees QAPI activities including patient experience surveys and reviews, clinical quality measure satisfaction (UDS measures, HEDIS measures, Annual Wellness Visits), pursuant to HRSA and PCMH requirements, value-based care agreements, pay for performance and other population health initiatives.
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Oversee Quality Improvement and HEDIS/STARS metrics improvement with PCP offices and IPAs. Become a part of our caring community and help us put health first. Assist with network development and provider contracting with various providers and ancillary providers.
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hedis job Title: decision support analyst Company: Highmark Health
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