New 
HEDIS Specialist
 Spectraforce Technologies | |||||||||||||||||||||||||||||||
 United States, North Carolina, Raleigh | |||||||||||||||||||||||||||||||
| 500 West Peace Street (Show on map) | |||||||||||||||||||||||||||||||
 Nov 17, 2024 | |||||||||||||||||||||||||||||||
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Title: HEDIS Specialist Duration: 6 Months (Potential to extend) Location: Remote - Nationally Sourced Responsibilities: * Develop and implement innovative strategies in collaboration with clinical staff to improve compliance with key behavioral health HEDIS metrics and Pay for Performance (P4P) Measures * Prepare and present financial impact and return on investment on initiatives requiring additional funding or resources * Act as a liasion with quality improvement, health plan medical management and other departments regarding current and planned interventions, collect input on how to impact these outcomes, and provide feedback to stakeholders on outcomes * Monitor the effectiveness for new and existing P4P and HEDIS initiatives and ensure appropriate knowledge/education and interventions are conducted for members falling into these measures * Analyze data to address trends or potential quality and clinical improvement opportunities based on best practices and feedback from involved stakeholders Responsibilities include retrieving medical records with clinical accuracy using remote access to Electronic Medical Record Systems while meeting daily productivity expectations. Accuracy and productivity rates are closely monitored to maintain a >95% accuracy rate, but also to be efficient and productive as compared to their peers. Additionally, perform RateMax duties including, but not limited to, medical record review for missed opportunities and provider chase leads, claims research, and chase activation.
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