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HEDIS Specialist II

Job Category:  Administrative, HR, Business Professionals
Department:  Quality Performance Management
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  8544

 

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.

Job Summary

The HEDIS Specialist II serves as a liaison between the Participating Provider Groups, HEDIS and the Healthcare Outcomes and Analysis Department. This position will also provide project management leadership to HEDIS related projects. This position supports ongoing processes that require routine data refreshes used for progress reports that impact the direct lines of business, providers, PPGs, and Plan Partners.

Duties

Acts as a liaison to the participating provider groups. Sets up processes and conducts requests to retrieve medical encounter, pharmacy, and laboratory data from the Participating Provider Groups which includes the IPA, medical groups, Plan Partners and provider offices. Manages a system to call the participating provider groups on a quarterly basis. Works with the analyst staff using various tools such as Microsoft Access to format the data and translate the data to meet the HEDIS vendor input specifications. This involves converting provider specialties into the provider types specified by the vendor.  Maintains a
system to follow up with the contacts. Provides technical assistance to external and internal partners. (35%)

 

Sets up processes, trains clerical staff, conducts quality control checks, and train staff. Creates study items for abstraction processes. Assists with the development of the Medical Record abstraction training manual. Conducts queries into Core System and Oracle to identify leads for medical records. Consolidates provider databases to assure correct phone numbers, faxes, and email addresses for providers. Updates the HEDIS tracker used for reporting the status based on medical record abstraction. Supports the schedulers when clinical assistance is needed. Supports schedulers and abstractors by providing back up as determined by work-load. (25%)

 

Conducts accurate medical record abstraction to meet a 100% accuracy rate. Abstract at least 70 records per day when assigned to medical record review for an 8 hour period). (20%)

 

Conducts data pulls from the databases for ad hoc requests for external and internal requests, Conducts queries and converts data into requested formats such as ASCII, Excel, etc. (10%)

 

Perform other duties as assigned. (10%)

Education Required

Associate's Degree

Education Preferred

Bachelor's Degree

Experience

Required:

At least 4 years experience working in HEDIS project in a healthcare or managed care environment.

 

Knowledge of coding and documentation concepts, guidelines, and clinical terminology.

Skills

Required:
Ability to interpret and analyze information to identify opportunities for more precise and/or complete documentation.

 

Excellent verbal and written communication skills.

 

Self-starter with ability to work independently.

 

Proficient in Microsoft Office.

 

Detail oriented.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Additional Information

 

L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)

 

At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.


Nearest Major Market: Los Angeles

Job Segment: Clerical, Pharmacy, Administrative, Healthcare

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