HEDIS Supervisor

Description

POSITION SUMMARY

The HEDIS Supervisor is responsible for overseeing the coordination and execution of all HEDIS-related functions, including data reporting, validation, and provider outreach, to ensure compliance with HEDIS, Medicare Star, and NCQA accreditation standards. This role provides leadership and guidance for complex data analytics and reporting requirements, ensuring alignment with regulatory expectations. The HEDIS Supervisor directs and supports a team of outreach staff, fostering a collaborative environment aimed at improving quality rates and addressing gaps in care. Working closely with cross-functional teams, this role plays a crucial part in driving quality improvement initiatives and maintaining the organization’s commitment to excellence in health plan performance.

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.

RESPONSIBILITIES

• Subject Matter Expertise: Act as the primary expert on HEDIS measures, the annual HEDIS process, and Medicare Star rating processes, guiding team performance and ensuring regulatory compliance.
• Data Management and Compliance: Oversee the accuracy and timely submission of all HEDIS data to software vendors, upholding data integrity and adhering to reporting timelines.
• Regulatory Compliance: Lead compliance initiatives, identifying, planning, communicating, and evaluating necessary actions to meet evolving regulatory, accreditation, and industry standards.
• Regulatory Analysis: Conduct timely analysis of regulatory materials (including CMS Call Letters, HEDIS Technical Specifications, and NCQA requirements) and provide strategic insights to support organizational alignment.
• Team Leadership and Outreach: Supervise HEDIS outreach staff, provide guidance and training to enhance engagement with members and providers, focusing on closing care gaps and improving quality ratings.
• Training and Collaboration: Collaborate with various departments to develop training materials for providers and members, ensuring accurate information distribution and compliance with program requirements.
• Consultation and Staff Training: Consult with and train staff on measurement specifications and requirements, ensuring that all team members are well-informed and compliant with HEDIS and Medicare standards.
• Performance Management and Task Coordination: Support performance evaluation processes by providing input on staff performance and development, while also assigning and coordinating daily tasks to ensure operational efficiency and goal achievement.
• Vendor Oversight: Provide direction to vendors responsible for HEDIS reporting and data abstraction, serving as the subject matter expert for abstraction projects and ensuring milestones are achieved.
• Project Management: Lead the annual HEDIS roadmap project, coordinating with departments to validate claims, pharmacy, utilization, and enrollment data for auditors and regulatory submissions.
• HEDIS Reporting: Manage the annual HEDIS reporting process, coordinating key functional areas to ensure standards are met, and guide the team through compliance processes.
• Audit Support and Improvement Initiatives: Support third-party audits by identifying trends, best practices, and training needs that can improve HEDIS performance, addressing any identified issues.
• Data Analysis and Quality Improvement: Analyze HEDIS rates, benchmarking data, and internal metrics to identify quality improvement opportunities and direct strategies that enhance health plan performance.
• Performance Metrics Supervision: Supervise concurrent and retrospective data review processes, ensuring accuracy in performance metrics and reporting.
• Status Reporting: Regularly compile and present status reports to the Total Quality Integration team and senior executives, highlighting progress, challenges, and opportunities for improvement.
• Data Integrity Assurance: Evaluate data integrity, identify potential deficits, and recommend solutions to improve data quality and ensure reliability across reports and submissions.
• Professional Development: Maintain professional and technical knowledge by attending educational workshops, reviewing relevant publications, establishing personal networks, and participating in professional societies to stay current with industry trends and best practices.

Qualifications

Education:

• Bachelor’s degree.

Experience/Skills:

• 2-3 Years HEDIS program experience required
• Able to monitor and meet program goals
• Comprehensive knowledge of standards; including HEDIS, STARs, CAHPS, HOS, and CMS.
• Prior STAR and HEDIS experience or participation with similar regulatory reporting.
• At least 3-5 years of healthcare experience to include experience in a managed care setting.
• Strong written and communication skills with the ability to write clear, structured, articulate, and persuasive improvement proposals.
• At least 3-5 years of experience with data analysis.
• Supervisory and/or management experience preferred.
• High level initiative, problem solving, and collaboration abilities
• Knowledge of Medicare and Medi-Cal regulations for managed care.
• Advanced experience using Microsoft office applications, including word-processing, and Excel.
• Experience working in deadline-driven environments.
• Required: Bilingual (Spanish)

Physical Requirements:

• Prolonged sitting.
• Frequent traveling, including driving with County of San Diego.
• May be required to work evenings and weekends.

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

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

Salary : $71,189 - $80,088