HEDIS/Risk Adjustment Coordinator

Job Description

Job Description

A HEDIS/Risk Adjustment Coordinator is a healthcare quality and data-management professional who helps health plans, medical groups, and provider organizations improve quality scores and ensure accurate documentation of patient conditions for reimbursement and reporting.

Position Summary

The HEDIS/Risk Adjustment Coordinator supports quality improvement and revenue optimization initiatives by coordinating activities related to HEDIS measures and Risk Adjustment programs. This role ensures accurate clinical documentation, medical record collection, and provider engagement to meet regulatory and organizational goals.

Key Responsibilities

•Coordinate HEDIS and Risk Adjustment chart review and medical record retrieval projects.

•Review medical records to identify gaps in HEDIS quality measures.

•Monitor quality metrics and risk adjustment performance reports.

•Track and report progress on quality improvement activities.

•Educate providers and staff regarding HEDIS requirements and coding guidelines.

•Assist with audits conducted by health plans and regulatory agencies.

•Maintain compliance with privacy regulations, including HIPAA requirements.

•Use electronic health record (EHR) systems and population health management tools to identify care gaps.

•Schedule and coordinate provider outreach and patient interventions when necessary.

•Additional assignments assigned by supervisor.

Required Qualifications

•High school diploma

•Strong organizational, communication, and analytical skills.

•Proficiency with Microsoft Office applications

Preferred Qualifications

•Experience working with Medicare Advantage, or managed care populations.

•Experience in healthcare administration, medical records, quality improvement, or managed care preferred but not required.

S&S Management Inc is a Management Services Organization (MSO).

Company Description

S&S Management Inc is a Management Services Organization (MSO).