HEDIS-Stars Coordinator

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing Whole-Person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 3,500 providers including Primary Care, Specialty, Hospital System and ancillary provider partnerships. We have operated in the Arizona market for more than 11 years, and are based in Chandler, Arizona. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

To assist, and communicate with the HEDIS/Stars team, administration and network providers regarding HEDIS/Stars program within the IPA community.

POSITION DUTIES & RESPONSIBILITIES

• Generate, review and distribute physicians’ daily and monthly reports and notifications.
• Produce daily reports to identify target membership for care gap closure initiatives across Medicaid & Medicare membership.
• Assist in care gap closures for measures that include, but are not limited to, Breast Cancer Screenings, Child & Adolescent Well Care Visits, Well-Child Visits, Timeliness of Prenatal Care and Follow-up after Mental Health Hospitalizations.
• Conduct member outreach, providing education and reminders to complete care gap opportunities.
• Communicates effectively with members & network providers, facilitating assistance for appointment scheduling opportunities.
• Request and review medical records, identify compliance requirements to conduct data entry into q.Metrics and supplemental databases.
• Assists in collaboration for process development to increase member compliance with HEDIS/Star measures.
• Use excellent customer service skills to contact members by phone, text, email and mail.
• Support and maintain an environment which fosters high customer service, employee satisfaction, and quality of service.
• Analyze Health Plan and Corporate reports in order to assist in the individualized request for medical records and scheduled encounters.
• Assist with processing weekly/monthly reports to management, providers and other Inter-departmental staff.
• Communicate with administration and Data Informatics to request modification of data and or report data disruptions.
• Prepare for auditing period with Health Plan insurance and CMS.
• Review annual updates on HEDIS measures and act as a resource for NCQA Standards relating to HEDIS.
• Perform other duties as assigned.

EDUCATION, TRAINING AND EXPERIENCE

• High school diploma – Required. College degree preferred.
• Arizona Medical Assistant certification required.
• Minimum 1 year experience in healthcare or managed care setting with responsibility for systems and/or projects.
• Knowledge of qMetrics, EzCap and NextGen preferred.
• Knowledge of HEDIS specifications preferred.
• Excellent written and oral communication skills.
• Ability to work independently once oriented to routine and process.
• Ability to find, gather and collect information or data.
• Intermediate level proficiency with Microsoft Office applications including Word, Excel, Power Point and Access.