(Archived) HEDIS Quality Program Manager

Position: HEDIS Quality Program Manager
Location: The Colony, TX
Shift: Full-time / Direct Hire / Permanent

Job Details

• Days/Hours: Monday-Friday 8am-5pm
• Travel: Travel 10% local travel within DFW Metroplex as needed for meetings
• Support the Quality Performance Improvement Department

Vendor Management:

• Selection of vendor, completion of contracting and monitors and manages the performance of all vendor systems
• Collaboration with Analytics for vendor monthly file extract (Monthly Rate Analysis and Data Integrity Checks), development/updates and Management of plan Supplemental Data Entry System to meet appropriate HEDIS specifications
• Facilitation of collection/Aggregation of supplemental data from across the plan, submission of supplemental data to HEDIS Vendor for inclusion in HEDIS vendor monthly file extract.
• Subject matter expert HEDIS Quality measures and Medicare Star Program
• Liaise with, and serve as key contact to external HEDIS vendors and auditors

HEDIS Chase and Administration

• Management of HEDIS Chart Chase Season (Vendor management, data validation coordination, pulling of sample, chase logic and strategies, medical record reconciliation)
• Annual HEDIS Audit Management (NCQA HEDIS Roadmap Completion, Primary Source Verification or PSV, Issue Log Management, Medical Record Question Log, Onsite Audit management, data accuracy and reporting, interacting with HEDIS auditors for regulatory compliance according to regulations)
• Develop and maintains a detailed HEDIS project plan to include milestones, tasks, and target/actual dates of completion
• Manage the HEDIS auditing process including the preparation of the HEDIS Roadmap and all other documents required by auditors
• Works with internal departments regarding data collection and submission.
• Responsible for providing leadership and direction to ensure the annual HEDIS submissions are delivered according to technical specifications and deadlines.
• Creates and makes formal presentations of trending reports throughout HEDIS cycle to keep executive management apprised of current status.
• Participate in the HEDIS review analysis to increase rates and evaluate and analyze annual HEDIS rates.
• Coordinates record retrieval with third party vendors and internal staff.
• Collaborates with internal departments for Supplemental Data process for HEDIS measures

Requirements

• Bachelor's Degree in Business Administration, Business Management, Computer Science, or relevant field: required
• Master's Degree: preferred
• Minimum of 4 years’ experience with a Health Plan / Medicare Advantage (MA) organization working with HEDIS Project Management, Chart Abstraction Vendor Relationships: required
• Minimum of 3 years’ experience in Project Management preferably related to HEDIS, Quality Improvement or other Accreditation Surveys Required Expert level knowledge of NCQA, HEDIS, Medicaid and Medicare is: required
• Thorough understanding of Statistics, Data Analytics, Modeling, Reporting Methods and Data Mining Methodologies: required
• Strong knowledge of STAR ratings: preferred
• Certified Professional Healthcare Quality (CPHQ) Certification: preferred
• Project Management Professional (PMP) Certification: preferred
• Six Sigma Green Belt or Black Belt Certification: preferred

For immediate consideration please create a profile and submit your resume through our applicant tracking system. Applications with attached resumes will be given first consideration. Visit us online at [Register to View] to learn more about our company and to view additional openings in your area.

About Us: All Medical Personnel is a national leader in healthcare staffing and recognized by Staffing Industry Analysts (SIA) as one of the nation's largest healthcare staffing firms. Our team of seasoned recruiters are experienced in their ability to recruit, screen and place medical professionals for all types of healthcare settings.