HEDIS Lead

Job Description

Job Description

Description:

Verda Healthcare, Inc. is a Medicare Advantage Prescriptions Drug Plan (MAPD) organization committed to the idea that healthcare should be easily and equitably accessed by all, currently available in Texas and Arizona. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a HEDIS Lead to join our growing company with many internal opportunities.

Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare health plan is looking for people like you who value excellence, integrity, care and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.

Align your career goals with Verda Healthcare, Inc. and we will support you all the way.

Position Overview
The HEDIS Lead is responsible for supporting the planning, coordination, implementation, and audit readiness of HEDIS initiatives across the organization. This position reports to the Senior Manager, HEDIS & Quality Improvement and works closely with the Stars Program Manager , delegated entities, providers, vendors, and internal operational teams to drive HEDIS and CMS Star Ratings performance.

The ideal candidate will possess extensive knowledge of HEDIS measures, NCQA requirements, medical record review and abstraction, Medicare Advantage operations, and HEDIS audit processes. This position serves as a key resource during HEDIS season and provides operational support for Data Quality Management (DQM) initiatives and other quality improvement projects.

Responsibilities:

HEDIS Program Support

• Support annual HEDIS project planning, implementation, and execution activities.
• Coordinate and monitor HEDIS data collection efforts with internal departments, delegated entities, and vendors.
• Perform and oversee medical record review and chart abstraction activities to support HEDIS reporting.
• Interpret HEDIS technical specifications and assist stakeholders with measure requirements and documentation standards.
• Monitor measure performance and identify opportunities for improvement.
• Assist with provider outreach and education related to HEDIS measures and documentation requirements.
• Support quality improvement projects focused on improving HEDIS and Stars outcomes.

HEDIS Audit Support

• Serve as backup lead for annual NCQA HEDIS Compliance Audit activities.
• Coordinate audit preparation, documentation requests, universes, and evidence submission.
• Support review and validation of medical record documentation and supplemental data sources.
• Partner with vendors, auditors, and internal teams to ensure compliance with NCQA requirements.
• Maintain audit readiness throughout the year for MAPD HEDIS reporting.

Stars Program Support

• Support the Stars Program Manager during HEDIS medical record season through chart abstraction and medical record retrieval.
• Collaborate on initiatives impacting CMS Star Ratings performance.
• Assist with monitoring and reporting of Star measure performance.
• Participate in provider education efforts related to Star measures and quality improvement initiatives.

Data Quality Management (DQM)

• Support DQM project planning, execution, and tracking.
• Assist with data validation activities to ensure accuracy and completeness of HEDIS and Stars reporting.
• Work with operational and technical teams to identify and resolve data quality issues.
• Participate in root cause analysis and corrective action planning.

Reporting and Collaboration

• Develop and maintain reports, dashboards, and project status updates.
• Present findings and recommendations to leadership and operational stakeholders.
• Participate in cross-functional meetings related to quality improvement, HEDIS, and Stars initiatives.
• Support departmental goals, strategic initiatives, and special projects assigned.

Preferred Qualifications

• Medicare Advantage health plan experience.
• Experience supporting CMS Star Ratings programs.
• Experience with HEDIS software platforms, data validation, and healthcare analytics.
• Knowledge of supplemental data, hybrid methodologies, and medical record retrieval processes.
• Experience managing multiple projects and deadlines in a fast-paced environment.

Professional Competencies

• Strong understanding of HEDIS, NCQA, CMS Star Ratings, and managed care quality programs.
• Excellent organizational and project management skills.
• Strong analytical, problem-solving, and critical-thinking abilities.
• Excellent verbal and written communication skills.
• Ability to collaborate effectively across departments and organizational levels.
• High attention to detail and commitment to data integrity.
• Ability to maintain confidentiality and exercise professional discretion.
• Self-motivated with the ability to work independently and manage competing priorities.

Verda Healthcare cares deeply about the future, growth, and well-being of its employees. Join our team today!

Job Type: Full-time

Location: Huntington Beach, CA

Compensation Range: $70,304-$85,000

Actual compensation offered will be determined based on experience, qualifications, skills, internal equity (if available), and geographic location. This position may also be eligible for performance-based incentive compensation and benefits.

Benefits:

· 401(k)

· Paid time off (vacation, holiday, sick leave)

· Health insurance 

· Dental Insurance

· Vision insurance 

· Life insurance

Schedule:

· Full-time onsite (100% in-office)

· Hours of operations: 9am – 6pm

· Standard business hours Monday to Friday/weekends as needed

· Occasional travel may be required for meetings and training sessions.

Ability to commute/relocate: Reliably commute or planning to relocate before starting work (Required)

PHYSICAL DEMANDS

Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.

* Other duties may be assigned in support of departmental goals.

Requirements:

• Bachelor’s degree in healthcare administration, Public Health, Nursing, Health Information Management, Business Administration, or related field required.
• Minimum of 3-5 years of healthcare quality experience within a health plan, IPA, MSO, managed care organization, or healthcare setting.
• Minimum of 2-3 years of HEDIS experience , including medical record review and abstraction.
• Experience supporting MAPD HEDIS reporting programs .
• Experience with NCQA HEDIS Compliance Audits and audit preparation activities.
• Knowledge of HEDIS technical specifications, medical record documentation requirements, and quality measurement methodologies.
• Experience working with delegated entities, providers, and healthcare vendors.
• Advanced proficiency with Microsoft Excel, Word, PowerPoint, and Outlook.
• Strong analytical and project coordination skills.