Hedis Coordinator

Rancho Cordova, CA

Instant Apply

1 day ago

Job Description

HEDIS Coordinator (Entry Level)

Job Summary

The HEDIS Coordinator supports medical record review, retrieval, provider outreach, and HEDIS submission activities. This role conducts provider and member outreach, supports care gap closure initiatives, maintains accurate records, and ensures timely completion of HEDIS-related assignments while meeting productivity and quality standards.

Responsibilities

Request and retrieve medical records from primary care providers, specialists, and various electronic medical record platforms.
Schedule onsite medical record retrieval visits as needed.
Negotiate with providers to support the successful and timely retrieval of medical records.
Manage and maintain HEDIS files and medical records.
Enter HEDIS medical record pursuit information accurately and thoroughly.
Develop knowledge of HEDIS hybrid measures and medical record requirements.
Research member claims and encounters to identify accurate information for medical record retrieval.
Review medical records and identify compliance elements.
Create and maintain detailed logs of member and provider interactions.
De-escalate challenging situations professionally.
Provide project support for member outreach and HEDIS initiatives.
Work independently in a fast-paced environment while managing competing priorities and frequent interruptions.
Complete assignments within specified timelines.
Collaborate effectively on team projects and special initiatives.
Conduct outbound calls to members and providers to collect information and support care coordination when needed.
Educate members about missing care gaps and encourage them to obtain needed services.
Provide administrative support, including generating correspondence, organizing mailings, coordinating schedules, and supporting training.

Requirements

High school diploma or equivalent.
At least two years of experience in health insurance operations, HEDIS audit support, member outreach, or inbound call campaigns.
Basic or proficient knowledge of job-related systems and procedures gained through education or work experience.
Proficient computer navigation skills, including the ability to work across multiple screens and applications.
Strong communication, interpersonal, organization, and customer service skills.
Critical thinking skills and effective time management abilities.
Ability to establish priorities and manage assignments efficiently.
Ability to maintain accurate notes, records, and documentation.
Knowledge of NCQA requirements, HEDIS audits, and HEDIS measures.
Working knowledge of Microsoft Office applications.

Skill

Medical record retrieval and review
Provider and member outreach
HEDIS compliance and quality improvement
Data entry and documentation
Claims and encounter research
Care gap identification and closure
Customer service and conflict de-escalation
Time management and prioritization
Computer navigation and Microsoft Office proficiency
Independent work and team collaboration

Summary Qualification

Entry-level HEDIS coordination experience with a strong understanding of medical record retrieval and quality initiatives.
Experience supporting health insurance operations, HEDIS audits, member outreach, or related healthcare activities.
Strong attention to detail with the ability to maintain accurate records and meet deadlines.
Effective communication and interpersonal skills for working with members, providers, and internal teams.
Ability to manage a high-volume workload, adapt to changing priorities, and work independently.

Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status.

Numbers & Facts

Location

Rancho Cordova, CA

Skills

Administrative Skillsunmatched
Campaignsunmatched
Candidate Screeningunmatched
Communication Skillsunmatched
Computer Skillsunmatched
Customer Support/Serviceunmatched
Data Entryunmatched
Detail Orientedunmatched
Documentationunmatched
Electronic Medical Recordsunmatched
Establish Prioritiesunmatched
File Maintenanceunmatched
Gap Closureunmatched
Health Insuranceunmatched
Healthcareunmatched
Healthcare Effectiveness Data and Information Set (HEDIS)unmatched
High School Diplomaunmatched
Interpersonal Skillsunmatched
Legalunmatched
Maintain Complianceunmatched
Medical Recordsunmatched
Microsoft Officeunmatched
Negotiation Skillsunmatched
Operational Auditunmatched
Operational Supportunmatched
Organizational Skillsunmatched
Primary Careunmatched
Purchasing/Procurementunmatched
Quality Assuranceunmatched
Quality Managementunmatched
Quality Metricsunmatched
Record Keepingunmatched
Time Managementunmatched

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