HEDIS Specialist I
HEDIS Specialist I
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Job Description
Lets do great things together!
About Moda
Founded in Oregon in 1955 Moda is proud to be a company of real people committed to quality. Today like then were focused on building a better future for healthcare. That starts by offering outstanding coverage to our members compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Lets be better together.
Position Summary
The Healthcare Effectiveness Data and Information Set (HEDIS) Specialist I position is responsible for the chart abstraction and review processes of Moda Healths HEDIS project. This position is key to year-round collection of medical records to help maximize HEDIS rates associated with our Commercial population and Marketplace stars. This position also supports the medical record review process during the annual HEDIS audit.
This is a FT WFH role.
Pay Range
$22.88 - $25.74 hourly (depending on experience)
*Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.
Please fill out an application on our company page linked below to be considered for this position.
Dental Vision Pharmacy Life & Disability
Required Skills Experience & Education:
- Associate or college degree or 1-2 years experience in a health-related field.
- HEDIS and/or medical records or health information technician background preferred.
- Clinical background to analyze the contents of the medical record preferred although no direct contact with patients is required.
- 1-2 years medical claim processing experience preferred dealing with all types of plans and claims and/or coding patients medical information for insurance billing or in medical records abstraction.
- Analytical problem solving memory retention organized and detail oriented.
- Ability to work independently well under pressure and with multiple stakeholders; ability to prioritize.
- Excellent verbal and interpersonal communication skills with internal and external customers.
- Proficiency with personal computer and Microsoft Office especially Excel.
- Project a professional business image telephonically and in person.
- Maintain confidentiality and privacy according to HIPAA regulations.
- Ability to come into work on time and daily.
Primary Functions:
- Performs year-round medical record abstraction from available Electronic Health Records (EHRs) and fax requests from provider offices.
- Acts as the liaison for the medical record retrieval and medical record abstractor vendors to help ensure HEDIS project milestones are met.
- Manages the communication with the record retrieval vendor to ensure all data needed to carry out contracted services is provided; follows up on these data requests and missing data elements.
- Troubleshoots providers office issues related to medical record collection.
- Assists in performing data validations during HEDIS production.
- Supports the HEDIS project manager in HEDIS production and post-production work plan activities.
- Performs quality reviews of retrieved medical records to determine completeness and accuracy according to the HEDIS technical specifications.
- Retrieves hard copy records from provider offices as needed.
- Participates in HEDIS continuous quality improvement within the job scope e.g. documenting policies and procedures provider data clean-up etc.
- Participates in the preparation of the NCQA-mandated annual HEDIS audit.
- Assists in designing and developing reports for internal customers.
- Other duties as assigned.
Working Conditions
Remote environment with extensive PC and keyboard work constant sitting and phone work. Must be able to navigate multiple screens. Works 40 hours per week Monday through Friday.
Together we can be more. We can be better.
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race religion color age sex sexual orientation national origin marital status disability veteran status or any other status protected by law. This is applicable to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absences compensation and training.
For more information regarding accommodations please direct your questions to Kristy Nehler & Danielle Baker via our email.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
