JOB DESCRIPTION

JOB TITLE: HEDIS®/Stars Coordinator II FLSA STATUS: Non-Exempt

DEPARTMENT: Quality Improvement

REPORTS TO: Quality Programs Manager, Imperial Health Plan

JOB SUMMARY: Under direct supervision of QI Leadership, responsible for coordinating NCQA Healthcare Effectiveness Data and Information Set (HEDIS®) and CMS Stars activities, ensuring compliance with regulatory requirements and quality standards. This role requires effective communication and the ability to manage competing priorities and work collaboratively with various departments and external provider offices.

ESSENTIAL JOB FUNCTIONS:

1. HEDIS® Data Collection: Coordinate the collection, validation, and submission of HEDIS® data in accordance with NCQA guidelines and timelines.
2. Quality Assurance: Ensure the accuracy and completeness of HEDIS® data by performing regular reviews of Cozeva / EDI reconciliation reports.
3. Compliance: Stay up to date with HEDIS® and Stars specifications and regulatory requirements, ensuring all processes and submissions comply with standards.
4. Documentation: Maintain detailed and accurate records of HEDIS® activities, including data collection methodologies, validation processes, and results. Ensure documented findings are reflected appropriately in the annual HEDIS® ROADMAP.
5. Data Analysis Support: Review HEDIS® data reports from Cozeva to identify trends and gaps to provide actionable insights to provider partners in the interest of improving healthcare quality and performance.
6. Reporting: Work with internal departments to prepare and maintain HEDIS® reports to management and external stakeholders and provider partners, highlighting key findings.
7. Training and Support: Help maintain and update training materials for internal and external stakeholders on HEDIS® measures, data collection procedures, and compliance requirements.
8. Process Improvement: Continuously evaluate and enhance documentation and inter-departmental coordination processes to improve efficiency, accuracy, and outcomes.
9. Collaboration: Work closely with healthcare providers, quality improvement teams, IT, and other departments to ensure seamless HEDIS® data collection and reporting.
10. Coordination: Ensure that meetings associated with HEDIS®/Stars activities and timelines, per applicable internal and external P&Ps and regulations, are timely and that invited parties have access to necessary information/documents to facilitate focused discussion. Also coordinates member and provider communications as appropriate when requested.

MARGINAL JOB FUNCTIONS:

BEHAVIORAL EXPECTATIONS:

1. Continuous Learning:

a. Attends staff meetings as required.

b. Attends appropriate training, seminars and workshops as required

2. Customer Focus:

a. Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations

and IMAS’s Standards of Conduct.

b. Fosters appropriate communication and relations with Manager, Supervisor, co-workers, and other staff.

3. Quality/Process Improvement/Safety

a. Reports issues of security, health and/or safety to appropriate manager as soon as practicable.

b. Supports and demonstrates safety throughout all duties performed.

c. Follows established policies and procedures and understands and complies with all regulators

standards set forth by governing entities.

POSITION REQUIREMENTS:

EDUCATION/EXPERIENCE:

SKILLS/KNOWLEDGE/ABILITY:

LICENSURE/CERTIFICATE/TRAINING: