Hedis Specialist

Key Responsibilities: Review and work HEDIS reports to identify open quality gaps and needed documentation. Utilize eClinical Works (eCW) EMR to review patient charts, clinical documentation, diagnoses, medications, referrals, and preventive care information. Perform medical chart audits to ensure accurate and complete documentation. Review medical records for HEDIS measures, quality indicators, and gaps in care. Assist with HCC/MRA coding and risk adjustment documentation review. Identify missing or incomplete clinical documentation and communicate findings appropriately. Assist with outreach and follow-up related to Medicare patient care needs and quality measures. Respond to Medicare patient questions and concerns in a professional and compassionate manner. Assist patients with understanding healthcare processes, appointments, referrals, and follow-up needs. Work with providers and clinical staff to obtain necessary documentation and close identified care gaps. Assist with referral-related activities and coordination of care as needed. Maintain accurate and confidential patient information in accordance with HIPAA requirements. Document patient interactions and follow-up activities in the eCW EMR.Maintain productivity, accuracy, and quality standards. Perform other duties related to HEDIS, quality improvement, and healthcare operations as assigned.

Required Qualifications: Experience working with HEDIS reports and/or HEDIS quality measures. Hands-on experience with eClinical Works (eCW) EMR.Experience with medical chart review and auditing. Knowledge of HCC/MRA coding and risk adjustment. Experience working with Medicare patients or Medicare-related healthcare programs. Strong understanding of medical terminology and healthcare documentation. Excellent attention to detail and organizational skills. Strong written and verbal communication skills. Ability to handle confidential patient information appropriately. Ability to work independently while also collaborating with providers and team members.

Preferred Qualifications: Experience with referrals and referral management. Experience in a primary care, Medicare, health plan, medical group, or quality department environment. Knowledge of HEDIS specifications and quality improvement processes. Experience performing chart reviews and identifying gaps in care. Experience with risk adjustment/HCC documentation. Familiarity with Medicare Advantage quality programs. Experience with healthcare outreach and patient engagement.

Ideal Candidate: The ideal candidate is organized, dependable, detail-oriented, and comfortable working with medical records, quality data, and the eCW EMR system. The candidate should be able to identify documentation gaps, navigate patient charts efficiently, communicate effectively with healthcare professionals and Medicare patients, and manage multiple priorities while maintaining accuracy and confidentiality.