Hedis Quality Auditor Jobs

Community Health Group is a locally based non-profit health plan that ensures access to high quality, culturally sensitive health care for underserved communities throughout San Diego County. We treat our 350,000+-member, multi-lingual staff like family, encouraging an atmosphere of collaborative teamwork, continuous learning, personal growth, and promotion from within. Recognized as one of the Top Workplaces in San Diego, CHG offers its employees such benefits as tuition reimbursement, a meditation room and yoga classes, a monthly Breakfast With The CEO, and memorable events throughout the year.

We know that by serving our employees well, they, in turn, will better serve our nearly 300,000+ membership. We have been recognized consistently for the excellence and sensitivity of our customer service by members, physicians, vendors, and a full range of health care providers. We are accredited by the National Committee for Quality Assurance and proud of our continuing company-wide Quality Initiatives.

We are currently recruiting for:

TITLE: HEDIS Quality Auditor

Target Hiring Range: $ 64,480.00- $ 72,530.00 Annually

EEO1: Administrative Support Worker

POSITION SUMMARY

The HEDIS Quality Auditor is responsible for quality assurance processes utilized by staff to ensure the integrity, completeness and validity of external and internal HEDIS reports. Must be able to analyze reports, identify correct methodology for extracting data, including data sources and criteria. Must ensure reports submitted to regulatory agencies are accurate, timely, and formatted appropriately. The HEDIS Quality Auditor works closely with providers and internal staff to ensure data collected is in accordance with prescribed quality standards; HEDIS measures, and internal protocols.

COMPLIANCE WITH REGULATIONS:

Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and DHCS.

RESPONSIBILITIES

• Understands how to prioritize reports according to business needs, regulatory requirements, urgency and other key business factors.
• Analyzes and performs quality assurance and data integrity checks on reports prior to submission.
• Develops reports to identify HEDIS care gaps and trends and works closely with providers and CHG staff to ensure the necessary services are provided and documented according to HEDIS requirements.
• Works closely with department leads to achieve the highest possible HEDIS/STAS scores.
• Works directly with HEDIS Manager on departmental and corporate initiatives and goals, such as maintaining a leadership position among California health plans.
• Provides training and guidance to providers and staff on HEDIS technical specifications and requirements.
• Assists with generation and review of State-specific performance measurement reports, such as SPD, MLTSS, etc.
• Collaborates with other departments to identify HEDIS data sources and develop systems to capture this data in accordance to HEDIS guidelines, such as supplemental databases.
• Is a subject matter expert on HEDIS technical specifications and STAR calculations.

EDUCATION

• Bachelor's Degree or equivalent combination of education and work experience.

EXPERIENCE/SKILLS

• Knowledge of basic statistics.
• Proficiency with data interpretation.
• Ability to handle multiple projects, data input, strong problem solving capability, excellent interpersonal/ communication skills.
• Proficient in MS Office.
• Two years in managed healthcare non-financial reporting.
• Working knowledge of ICD-10/CPT/HCPCS/NDC coding, medical terminology and knowledge of managed care, claims payment processes and insurance terminology required.
• Minimum five years of experience in healthcare.
• Excellent technical, interpersonal, written and oral communication skills required.
• Experience in a Medicare and Medi-Cal environment preferred.
• HEDIS reporting or collection experience.
• Proficiency with Excel and demonstrated ability to learn new information systems and software programs.

PHYSICAL REQUIREMENTS

• Occasional driving within San Diego County
• High frequency of local driving.
• May be required to work evenings and/or weekends.
• Prolonged periods of sitting.

**Must have current authorization to work in the USA**

Community Health Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and trainings. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, see Personnel Policy 3101 Equal Employment Opportunity/Affirmative Action.