Hedis Coordinator

Job Description

Job Description

Benefits:

• Bonus based on performance
• Company parties
• Dental insurance
• Health insurance
• Opportunity for advancement
• Paid time off
• Vision insurance

Position Summary

Florida Doctors Group MSO is seeking a HEDIS & Quality Coordinator responsible for supporting our provider network in meeting HEDIS, preventive care, and quality performance requirements.

This position will work directly with providers, medical office staff, health plans, and the FDG internal team to identify and close care gaps, obtain and review medical records, track HEDIS measures, educate provider offices, and ensure appropriate documentation is submitted within required timeframes.

The ideal candidate should be highly organized, comfortable communicating directly with medical practices, and able to manage multiple provider and member-level quality initiatives simultaneously.

Key Responsibilities

• Monitor and track HEDIS measures and open care gaps across assigned providers and health plans.
• Review health plan reports, dashboards, and member-level gap reports to identify opportunities for improvement.
• Contact provider offices regularly regarding outstanding HEDIS measures and members requiring follow-up.
• Coordinate with provider offices to obtain medical records, lab results, screening documentation, encounter information, and other supporting documentation .
• Review documentation to determine whether HEDIS requirements appear to have been satisfied and submit appropriate records to the applicable health plan or internal department.
• Maintain detailed tracking of open, pending, submitted, and completed care gaps .
• Assist provider offices with understanding HEDIS requirements and the documentation needed for specific measures.
• Educate providers and office staff on the importance of preventive screenings, chronic disease management, follow-up care, and accurate medical-record documentation.
• Coordinate outreach initiatives for members who are due or overdue for recommended services.
• Follow up with provider offices to confirm appointments, completed services, and outstanding documentation.
• Work with health plans to reconcile discrepancies between provider records and health plan HEDIS reports.
• Assist with medical-record retrieval and HEDIS chart review activities.
• Track provider performance and identify practices requiring additional education or intervention.
• Prepare internal reports summarizing care-gap closure rates, outstanding measures, provider performance, and follow-up activity .
• Participate in health plan HEDIS and quality meetings, webinars, and training sessions as required.
• Stay informed regarding annual changes to HEDIS measures, health plan quality initiatives, and applicable CMS quality programs.
• Work collaboratively with FDG's Provider Relations, Coding/Risk Adjustment, Credentialing, Contracting, and other departments when necessary.
• Document all provider outreach, follow-ups, submissions, and resolutions accurately and timely.
• Escalate providers or outstanding items requiring management intervention.
• Maintain confidentiality and comply with HIPAA and all applicable privacy requirements .

HEDIS Measures

The coordinator should develop working knowledge of applicable measures, including areas such as:

Preventive Care: Breast Cancer Screening (BCS), Colorectal Cancer Screening (COL), Care for Older Adults (COA), Annual Flu Vaccine, and other age-appropriate preventive services.

Chronic Disease Management: Blood Pressure Control, Diabetes-related measures, HbA1c testing/control, kidney health evaluations, medication adherence, and other applicable chronic-care measures.

Transitions & Follow-Up: Transitions of Care (TRC), post-discharge follow-up, medication reconciliation, and other measures involving continuity and coordination of care.

Applicable measures may change based on NCQA specifications, CMS requirements, health plan programs, and measurement year.