HEDIS Patient Care Advocate

Job Description

Job Description

BCforward is currently seeking a highly motivated HEDIS Patient Care Advocate for an opportunity in Elkhart, IN 46516

Position Title: HEDIS Patient Care Advocate

Location: Elkhart, IN 46516

Duration: 3 months with possibility to extend

Shift Timing: Monday–Friday, 8:00 AM–5:00 PM.

Pay Rate: $34/hr

 

Position Summary

The Patient Care Advocate serves as a liaison between members, families, healthcare providers, medical groups, and facilities. This role focuses on member outreach, care-gap closure, appointment coordination, health education, and provider quality improvement .

The selected candidate will work directly within assigned provider/clinical facilities and must be comfortable working independently while communicating with members, providers, and internal teams.

Key Responsibilities

• Serve as a liaison and advocate between members/families, physicians, providers, medical groups, and healthcare facilities.
• Work directly with provider office staff to support healthcare quality and member outcomes.
• Conduct telephonic outreach and health coaching to members.
• Conduct face-to-face education with members and families regarding identified care gaps and barriers to care.
• Identify members who have gaps in preventive or required healthcare services and help coordinate appropriate follow-up.
• Schedule doctor appointments for members to address care gaps and improve access to preventive care.
• Arrange transportation and follow-up appointments when needed.
• Educate provider practices regarding HEDIS measures and HEDIS-related ICD-10/CPT coding in accordance with NCQA requirements.
• Review provider performance data and identify opportunities for quality improvement.
• Work with Provider Relations and other departments to improve provider performance related to Quality, Risk Adjustment, Operations, claims, and encounters .
• Coordinate with Customer Service, Case Management, Disease Management, and other departments to resolve member issues.
• Refer members to case management or disease management programs when appropriate.
• Maintain accurate documentation of member contacts, outreach activities, appointments, referrals, and follow-up.
• Complete special projects and other duties as assigned.
• Follow all company policies, procedures, and regulatory requirements.

Candidate Requirements

Required Education / Experience

• Bachelor's degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or a related healthcare field , OR equivalent work experience .
• A total of 4 years of relevant experience is required.
• At least 2 years of experience should ideally be in:
• • Direct patient care
  • Social work
  • Quality improvement
  • Health coaching
  • Managed care
• Experience working in an ambulatory/outpatient healthcare practice is required.
• Experience with HEDIS review, chart abstraction, or HEDIS measures is highly relevant.

Preferred Licensure / Certification

One of the following is preferred:

• RN – Registered Nurse
• LPN – Licensed Practical Nurse
• LMSW – Licensed Master Social Worker
• LSW – Licensed Social Worker

C-SW – Certified Social Worker