HEDIS Coordinator at Somatus
Remote
Summary:
TheHEDISCoordinator willperform the functions related to the outreach, collection, andaccurate data entering of medical records and service data according to HEDIS / Somatus Technical Specifications. The primary focus of this role will be to analyze and process the information collected and review the applicable medical records and clinical criteria.
Essential Duties and Responsibilities:
Coordinate, complete, and update management on all HEDIS processes and results.
Work with providers and internal departments on rate investigation and validation activities, which includesmaintaining all evidence, documentation, and changes.
Call patients to schedule appointments,develop recommendations for quality improvement activities for our providers and collaboratewith other departments on these activities.
Engage positively with members, peers, and clinic staff.
Collect and enter clinical information from medical records into various tools and databasesin accordance with HEDIS technical specifications as well asSomatus and health plan specifications.
Remain updated on NCQA HEDIS Technical Specifications as it applies toSomatus and partner health plan quality programs.
Interface with data support, quality assurance team, HEDIS Quality Manager, and IT to collect data andmaintain the various health plan tools.
Filing, faxing, copying, and scanning of files.
Strive to meet personal,departmental, and organizational goals and targets.
Complete assignments within specified timelines.
Prepare andmaintain records and files that are organized, thorough and readily accessible.
Attend team meetings and report findings of data collection as well as barriers or opportunities.
When a problem isidentified, informsupervisorin a timely manner.
Transmit ideas and information in a clear and concise manner.
All other duties as directed by management.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
Required Education and Experience:
Required
Preferred
Knowledge, Skills, and Abilities :
Strong attention to detail, organizational, time management and analyticalskills.
Self-starterwhowilltakeinitiativeandbeproactive with the ability to manage multiple, competing priorities with minimal oversight.
Strategicsolution-seekerwhoseesopportunitieswhenothersseebarriers.
Able to work well in a team environment on special projects.
Excellent written,verbal and organizational skills.
Ability to build andmaintain collaborative relationships with key members of other departments within the organization.
Abilitytohandle ambiguityanddesiretoworkinafast-pacedenvironment.
knowledge andproficiency with all Microsoft tools including PowerPoint, Excel, Outlook, etc.
Physical Requirements
This joboperates in a professional office setting.While performing the duties of this job, the employee is regularly required to sit or stand for extended periods of time. Normal manual dexterity isrequired.
Normal speaking and hearing abilities to interact with others in an office environment, over telephone or other video conferencing platform.
The employeeis occasionally required tostand; walk; and reach with hands and arms and continuously repeat the same hand, arm finger motion many times as in typing.
OTHER DUTIES:
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 Vaccination is required for employment. If you are unable to be vaccinated for medical reasons or sincerely-held religious beliefs, we will consider requests for reasonable accommodations consistent with our policy, and where we are able to provide such accommodations without undue hardship to the company.? All requests for proof of vaccination or for exemptions from the vaccination requirement will be subject to any limitations stipulated by current state and/or federal laws.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Somatus, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Further, the company takes affirmative action to ensure that applicants are employed, and employees are treated during employment without regard to any of these characteristics. Discrimination of any type will not be tolerated.
