AddressDescription
HEDIS Lead (JR111570)
Location : Must reside within 50 miles and 1 hour commute of an Elevance Health PulsePoint – main office location. This position requires working 1 day/week in the local office.
The HEDIS Lead is responsible for coordinating, implementing, and executing HEDIS Quality Department specific projects, ensuring consistency with company strategy, commitments, and goals. Primary duties may include, but are not limited to:
Leads annual HEDIS medical record collection and abstraction process; synthesizes aggregate plan and product level data medical record data; establishes the baseline and measures the change, data gathering, presentation, and interpretation for optimal HEDIS data/results.
Prepares and maintains project plans and schedules inclusive of tasks, timelines, resources, milestones, dependencies, and assumptions.
Leads teams regarding work flow process improvement, document management, and abstraction education.
Trains and leads onsite temporary staff.
Evaluates and monitors performance and efficiency of programs to ensure that implementation meets targeted timelines.
Collaborates with multiple departments and external vendor to annually field a new HEDIS pursuit application.
Requirements:
AA/AS in healthcare field and minimum of 2 years experience with HEDIS activity coordination or working with Managed/Acute/Provider Care environment, including 2 years of analytical experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Qualifications:
RN, LVN, RHIA, or RHI license preferred.
Proficiency using Member 360, MS Excel, and/or use of claims extraction platforms such as Cotivity, Reveleer, MRDB, or similar, strongly preferred.
Experience using one or more EMR systems.
Experience with CPT codes and/or researching claims a plus.
HEDIS experience within Medicare strongly preferred.
NCQA experience preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.
