Summary

The Quality Improvement HEDIS Part C Specialist performs a key role in ensuring healthcare providers excel in meeting Quality Measures consistent with the CMS Star Rating Program. This position is responsible for medical record reviews, audits, and performance tracking for several providers as assigned. Works closely with each provider to educate and identify areas of improvement ensuring compliance with regulatory guidelines. This position will require strong organization, communication skills, and feedback to achieve maximum CMS Star Ratings every year. Assists with other clerical duties as required.

Essential Duties and Responsibilities

• Conducts monthly reviews in a timely manner and in accordance with established guidelines.
• Tracks compliance issues, trend data, prepares regular reporting to enhance performance related to HEDIS measures, and distributes to providers and internal teams.
• Stays informed about the HEDIS measure requirements and applicable annual updates.
• Prepares, submits, and bill findings to external stakeholders, ensuring adherence to reporting deadlines.
• Presents a summary of all tracking reports to identify areas of improvement monthly or upon request.
• Engages physicians and office staff to build and maintain a good working relationship.
• Local road travel of at least 40% required(Miami-Dade and Broward Counties)
• Handles and manages confidential information and/or issues using professional discretion and judgment.
• Performs other related duties as assigned.

Knowledge, Skills and Abilities

• Strong organizational skills with keen attention to detail
• Ability to handle time-sensitive information, manage priorities and workflow.
• Excellent verbal and written communication skills.

• Strong interpersonal skills and proven customer service skills.
• Proven customer service skills and demonstrated ability to deal effectively with a diversity of individuals.
• Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm.
• Proficient with Microsoft Word, Excel, Outlook and Teams.
• Proven ability to handle multiple projects and meet deadlines.

Minimum Education and Experience

• Some college, plus two years of related professional work experience, or equivalent combination of education and experience.
• Two years of call center and/or front desk experience preferably within a healthcare office environment.
• Bilingual (English and Spanish) required.
• Proven ability to use MS Office and perform diverse clerical functions within a professional work environment.

Genuine Health Group offers a competitive compensation and benefits package that includes a 401k matching program, fully subsidized medical plans, paid holidays and much more. Base salary will be commensurate to professional experience.

Genuine Health Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.