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Hedis Clinical Coordinator

River City Medical Group

This is a Full-time position in Sacramento, CA posted August 14, 2019.

Job Summary: The HEDIS Clinical Coordinator will be responsible for coordinating, collaborating and completing HEDIS Department Quality Improvement activities that are consistent with company strategy, commitments, and goals.

Essential Job Functions: Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the position.

•Audits and analyzes HEDIS provider data, developing recommendations for quality improvement activities for our providers and collaborating with RCMG management and other departments on these activities.

•Schedules and visits physician practices to implement HEDIS best practice solutions.

•Assists physician practices to identify opportunities to optimize HEDIS encounter data.

•Documents in appropriate systems and communicating with team members and management.

•Assists management in implementing key quality strategies.

•Works closely with affiliated entities on provider interventions, data collection and other quality-related projects.

•Audits and monitors internal department processes and materials for compliance with regulatory and accreditation standards related to HEDIS and assisting those departments on correcting any deficiencies.

•Communicates with internal departments, external companies and data sources as needed for data aggregation activities.

•Creates communications such as newsletters or provider education materials.

•Work with internal programs to run reports, summarize performance data, identify opportunities and relate information effectively to providers and management.

•Assists with HEDIS data evaluation and reporting to affiliated entities.

•Complete all company required trainings and external continuing education to keep licensure current.

•Performs related duties consistent with the scope and intent of the position.

•Regular attendance.

•Travel as required.

Other Functions:
•Enforces Company policies and safety procedures.

•Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.

•2 years of experience in a quality improvement required.

•2 years of experience working as an LVN is required.

•2 years HEDIS role preferred.

•2 years of experience with medical coding/billing, specifically ICD-10 and CPT coding preferred.

•2 years of any other combination of skills/experience related to HEDIS will be considered.

•Must have ability to accurately read, understand and interpret medical records.

•Proven ability to work autonomously and proactively implement quality improvement strategies.

•Strong understanding of HEDIS measures, coding, claims, billing and EHR systems.

•Strong computing proficiency, including reporting software, email and Microsoft Office.

•Ability to work as a cohesive team and collaborate with internal departments.

•Excellent communication, organization, and problem solving skills with attention to detail.

•Ability to enlist the support and actions of affiliated physicians to effectuate change, overcome barriers and convince others to implement known best practice solutions.

•Ability to demonstrate professionalism, integrity and strictly adhere to confidentiality standards set forth by the Health Insurance Privacy and Accountability act.

•Exceptional written and verbal communication, flexibility and time management skills.

•Ability to occasionally work outside normal business hours and travel locally.

•Ability to multitask and prioritize work load in a fast-paced environment with changing priorities and multiple deadlines.

•Effectively present HEDIS information in 1:1 or group settings and answer all related questions.

•Excellent active listening and critical thinking skills.

•Ability to solve mid-level problems with minimal supervision.

•Ability to demonstrate professionalism, confidence, and sincerity while quickly and positively engaging providers.

•Demonstrated excellence in project management and organization.

•Ability to provide and receive constructive job and/or industry related feedback.

•Ability to maintain confidentiality and appropriately share information on a need to know basis.

•Ability to exercise sound discretion and strict maintenance of confidentiality of all confidential and sensitive communications and information.

•Ability to consistently deliver excellent customer service.

•Excellent attention to detail and ability to document information accurately.

•Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives.

•Demonstrate commitment to the organization’s mission.

•Must have mid-level skills in Microsoft software (Word, Excel, PowerPoint).

•Must have the ability to quickly learn and use new software tools.

•Must have mid-level skills using e-mail applications.

•Self-motivated with strong organizational, multi-tasking, planning, and follow up skills.

•Ability to work independently as well as in a team environment.

•Ability to present self in a professional manner and represent the Company image.

Supervisor Responsibility
•This position does not have any supervisor responsibilities.

Education and Licensure
•High School Diploma or GED required
•Current and Valid California License in the following disciplines is required: Licensed Vocational Nurse
•Current California Driver’s License is required Travel
•The incumbent may travel up to 40% of the time in the greater Sacramento area and surrounding rural areas.

Work Environment This job operates in a professional office environment.

This role routinely uses office equipment such as computers, phones, photocopiers, scanners and filing cabinets.

Mental and Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing this job, the employee is regularly required to talk or hear.

The employee frequently is required to stand; walk; use hands to finger, handle, or feel; and reach with hand and arms.

The employees is occasionally required to sit; climb or balance; and stoop, kneel, crouch or crawl.

The employee may occasionally lift and/or move up to 10 pounds.

Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.

Experiences frequent interruptions; required to meet inflexible deadlines; requires concentration and attention to detail; requires a high level of organizational and prioritization skills.

Required to sit for prolonged periods; exposed to visual display terminal for prolonged periods; dexterity and precision required in the operation of a computer.

Other Duties Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.

Duties, responsibilities and activities may change at any time with or without notice.


Keywords: Clinical Services Coordinator, Location: Sacramento, CA
– 95811