What are the responsibilities and job description for the Quality/HEDIS Coordinator position at DOCTORS HEALTHCARE PLANS, INC.?
Position Summary:
Doctors HealthCare Plans is a Medicare Advantage health plan serving South and Central Florida. The HEDIS Coordinator supports the organization's HEDIS and CMS Star Ratings initiatives by coordinating medical record retrieval activities, conducting chart reviews, maintaining provider relationships, presenting performance data, and leading provider-focused quality improvement efforts.
This position serves as the primary quality liaison for assigned provider groups and is responsible for collaborating with providers, office staff, and internal stakeholders to improve HEDIS performance, close gaps in care, enhance documentation practices, and support overall Star Ratings performance.
This is a field-based position requiring regular travel throughout Miami-Dade and Broward Counties. The ideal candidate is comfortable working independently, leading provider meetings, presenting performance data, facilitating quality improvement discussions, and building strong relationships with physicians and provider office staff.
Key Responsibilities:
Doctors HealthCare Plans is a Medicare Advantage health plan serving South and Central Florida. The HEDIS Coordinator supports the organization's HEDIS and CMS Star Ratings initiatives by coordinating medical record retrieval activities, conducting chart reviews, maintaining provider relationships, presenting performance data, and leading provider-focused quality improvement efforts.
This position serves as the primary quality liaison for assigned provider groups and is responsible for collaborating with providers, office staff, and internal stakeholders to improve HEDIS performance, close gaps in care, enhance documentation practices, and support overall Star Ratings performance.
This is a field-based position requiring regular travel throughout Miami-Dade and Broward Counties. The ideal candidate is comfortable working independently, leading provider meetings, presenting performance data, facilitating quality improvement discussions, and building strong relationships with physicians and provider office staff.
Key Responsibilities:
Medical Record Retrieval & Management
- Contact provider offices to request medical records and coordinate onsite or remote retrieval activities.
- Retrieve medical records through provider office visits, EMR systems, secure portals, fax, or other approved methods.
- Upload, organize, and maintain medical records within designated company repositories and tracking systems.
- Maintain accurate documentation of records requested, received, reviewed, pending, and completed.
- Monitor and follow up on outstanding record requests to ensure project deadlines are met.
- Ensure timely completion of medical record collection activities in support of HEDIS and quality initiatives.
- Maintain familiarity with annual HEDIS measure specifications, CMS Star Ratings requirements, and documentation standards.
- Perform medical record reviews to identify documentation supporting HEDIS measures and quality initiatives.
- Identify open gaps in care, missing documentation, and opportunities for performance improvement.
- Assist with validating medical record completeness and supporting audit readiness efforts.
- Serve as the primary Quality/HEDIS point of contact for assigned provider groups.
- Develop and maintain strong working relationships with physicians, provider office leadership, clinical staff, and administrative personnel.
- Schedule, coordinate, and lead quality meetings with assigned provider groups and internal stakeholders.
- Present provider scorecards, quality reports, HEDIS performance results, open gaps in care, Star Ratings measures, and performance trends.
- Facilitate discussions with providers and office staff regarding barriers to performance improvement and strategies to improve measure compliance.
- Conduct provider education regarding HEDIS measures, CMS Star Ratings requirements, clinical documentation standards, and annual measure updates.
- Monitor provider progress toward quality goals and follow up on action items identified during meetings.
- Document meeting outcomes, recommendations, action plans, and provider commitments.
- Assist providers with understanding scorecards, gap lists, quality reports, and performance improvement opportunities.
- Support provider engagement initiatives designed to improve quality performance, clinical outcomes, and CMS Star Ratings results.
- Maintain HEDIS tracking logs, provider engagement records, retrieval status reports, and quality improvement documentation.
- Assist with monitoring provider performance and reporting project status to leadership.
- Validate provider contact information, office locations, HEDIS contacts, and retrieval methods.
- Prepare reports, summaries, presentations, and supporting documentation for provider meetings and quality initiatives.
- Ensure documentation is maintained according to organizational policies and regulatory requirements.
- Maintain strict confidentiality of member and provider information.
- Comply with HIPAA, CMS, AAAHC, organizational policies, and all applicable regulatory requirements.
- Ensure proper handling, storage, transmission, and protection of protected health information (PHI).
- Adhere to departmental procedures for record management, quality reporting, and provider engagement activities.
Required Qualifications:
- High school diploma or equivalent.
- Bilingual in English and Spanish.
- Minimum of 2 years of experience in healthcare, medical records, quality improvement, provider relations, healthcare operations, or a related healthcare environment.
- Experience working with electronic medical record (EMR) systems.
- Experience conducting provider outreach and professional business communications.
- Strong organizational, analytical, and problem-solving skills.
- Strong verbal and written communication skills.
- Ability to independently lead meetings and present information to provider offices and stakeholders.
- Ability to analyze performance reports and identify opportunities for improvement.
- Proficiency with Microsoft Office applications, including Outlook, Word, Excel, PowerPoint, and Teams.
- Ability to manage multiple priorities while meeting established deadlines.
- Ability to maintain confidentiality and handle sensitive information appropriately.
- Reliable transportation and ability to travel throughout Miami-Dade and Broward Counties.
- Experience with Medicare Advantage, managed care, IPA/MSO organizations, health plans, provider network operations, or value-based care programs.
- Knowledge of HEDIS and CMS Star Ratings.
- Experience presenting scorecards, quality performance reports, dashboards, or operational metrics to providers or healthcare leadership.
- Experience facilitating meetings and leading discussions with physicians, provider leadership, and cross-functional teams.
- Experience with medical record retrieval, chart review, provider engagement, audit preparation, or healthcare quality projects.
- Familiarity with medical terminology, preventive care measures or chronic condition management.
- Associate's or Bachelor's degree in Healthcare Administration, Public Health, Health Information Management, Nursing, or a related field.
- Frequent local travel within Miami-Dade and Broward Counties.
- Ability to conduct routine provider office visits.
- Ability to transport a laptop and work materials.
- Ability to sit, stand, and use a computer for extended periods.
- Valid driver's license and reliable transportation required.
Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.
No Third Party Agencies or Submissions Will Be Accepted.
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.