HEDIS/Stars Coordinator

Job Description

POSITION SUMMARY

This position is responsible for the coordination of HEDIS and Stars program, including gap closure, comprehensive data submission, monitoring and reporting accuracy. The Stars coordinator will be responsible for Stars improvement by supporting HEDIS and Star program data gathering process, completing member & provider outreach as needed, and developing strategies for member experience and quality of service enhancement.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job, an individual must perform each essential function satisfactorily, with or without reasonable accommodation, including, but not limited to:

• Responsible for formulating/implementing and executing all Star quality program processes, requests, workflows or policies as requested by management in a courteous and efficient manner, including offering a proactive approach to suggestions and recommendations
• Download pull lists and perform provider/member outreach as required
• Coordinate with provider staff schedule remote or onsite record reviews
• Access HEDIS data repository or Ensure Data Solutions to continually monitor areas of improvement on HEDIS gap closure
• Create Power Point decks and other training material for internal and external meetings
• Develop, monitor and report performance for improvement activities
• Attend health plan Joint Operating Meetings (JOM) and other quality meetings
• Attend on-site medical group provider meetings regarding quality measures
• Additional duties as assigned

SUPERVISORY RESPONSIBILITY

People Leadership

• No.

QUALIFICATIONS AND EDUCATION

Required Qualifications

• High School graduate or GED equivalent; College degree preferred Minimum two-years’ experience working in a health plan or IPA environment conducting HEDIS/Star activities and/or medical record reviews
• Willing to travel locally to provider offices.
• Bilingual English & Spanish and/or Creole.

Preferred Qualifications

• 2+ years of college, in pursuance of a Bachelor's or Associate's degree in Health Care.

Core Competencies

• Attention to detail and quick learner
• Excellent verbal, written communication and interpersonal skills Excellent organizational skills and ability to multitask
• Ability to work well in a busy department
• Able to stay focused in a fast-paced environment

WORKING CONDITIONS

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• The noise level in the work environment is usually moderate.
• Works in the field
• Interacts with patients, family members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances.

This work requires the following physical activities: climbing, bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed indoors. Sits, stands, bends, lifts, and moves intermittently during working hours. May be sitting for a prolonged period.

The work schedule is approximate, and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including weekends and holidays as needed. May require some OT during varying seasons of the year.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

The employee must be able to frequently lift up to 10 pounds and occasionally lift and/or move up to 25 pounds. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand and walk. The employee is occasionally required to use hands to finger, handle, or feel; reach with hands and arms; climb or balance and stoop, kneel, crouch, or crawl. Specific vision abilities required for this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

PERFORMANCE MEASUREMENTS

• Duties accomplished at the end of the day/month.
• Attendance/punctuality.
• Compliance with Company regulations.
• Safety and Security.
• Quality of work.

This Job Description may be modified at any time at the discretion of the employer as business operations may deem necessary. This does not constitute an employment agreement and may not include all duties.

The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with a demonstrated ability to juggle and prioritize multiple competing tasks and demands and to seek supervisory assistance as appropriate.