Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
Job Description
The HEDIS Reviewer and Auditor – Health Plan is responsible for conducting comprehensive reviews and audits of healthcare data to ensure accurate and complete reporting for the Healthcare Effectiveness Data and Information Set (HEDIS). This role involves identifying and analyzing data trends, extracting clinical information from medical records, and verifying compliance with HEDIS standards. The HEDIS Reviewer and Auditor – Health Plan collaborates with quality improvement teams to support performance improvement and regulatory requirements, ensuring data accuracy, consistency and alignment with quality measures.
Key Outcomes:
Performs clinical chart reviews and audits to ensure accuracy and compliance with HEDIS measures.Develops reports to identify HEDIS care gaps and trends and works closely with providers to ensure the necessary services are provided and documented according to HEDIS requirements.Prioritizes reports according to business needs, regulatory requirements, urgency, and other key business factors.Assists in the coordination of outreach efforts to request, collect, and secure clinical documentation from individual providers or provider groups as indicated by individual HEDIS measure specifications.Collaborates with health plan departments to identify HEDIS data sources and develop systems to capture this data in accordance with HEDIS technical specifications, such as supplemental databases. Collaborate with data analysts and quality teams to support performance improvement.Documents findings and prepare reports to support HEDIS submissions.Completes annual training provided and meet and maintain competency and acceptable performance goals.Other duties and responsibilities, as assigned.Education/Experience:
Associate degree or combination of relevant education and experience.3+ years of experience in the health care industry, in HEDIS and/or quality improvement.Experience in a managed care health services environment.NCQA and HEDIS experience.Required License(s) and/or Certification(s):
Certified Coder (Preferred) or Medical Assistant (Preferred)Skills/Knowledge/Competencies (Behaviors):
Demonstrated knowledge of data collection, medical record review, and data extraction.Excellent communication, organization and writing skills.Ability to effectively prioritize work, multi-task, and achieve goals on time; work independently and to self-motivate.Excellent critical thinking skills.Keen attention to detail.Ability to work effectively and collaboratively with internal and external stakeholders.Knowledge of, and skills in, data collection, analysis, and presentation.Excellent oral and written communication skills.Must demonstrate integrity, sound judgement and strong interpersonal skills.Strong knowledge of medical terminology.Must be able to address quality issues with tact and diplomacy.Proficient use of MS Office with a focus on Excel and report writing software.Proficiency in use of electronic medical records and computer applications.There are additional competencies linked to individual contributor, provider, and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.
We are an equal opportunity/affirmative action employer.
Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org