HEDIS/Stars Coordinator II

Job Summary

Imperial Health Plan of California, Inc. is seeking a HEDIS®/Stars Coordinator II to join our Quality Improvement Department. Reporting to the Quality Programs Manager, this non-exempt role is responsible for coordinating NCQA Healthcare Effectiveness Data and Information Set (HEDIS®) and CMS Stars activities. The position requires ensuring compliance with regulatory standards and quality objectives, effective communication, and the ability to manage multiple priorities while collaborating with various internal departments and external provider offices.

Essential Job Functions

• Coordinate the collection, validation, and submission of HEDIS® data according to NCQA guidelines and deadlines.
• Ensure the accuracy and completeness of HEDIS® data through regular reviews of Cozeva / EDI reconciliation reports.
• Maintain up-to-date knowledge of HEDIS® and Stars specifications and regulatory requirements, ensuring all processes and submissions adhere to these standards.
• Keep detailed and accurate records of all HEDIS® activities, including data collection methods, validation procedures, and outcomes, ensuring findings are documented in the annual HEDIS® ROADMAP.
• Support data analysis by reviewing HEDIS® data reports from Cozeva to identify trends and gaps, providing actionable insights to provider partners to enhance healthcare quality and performance.
• Prepare and maintain HEDIS® reports for management, external stakeholders, and provider partners, highlighting key findings.
• Assist in maintaining and updating training materials for internal and external stakeholders on HEDIS® measures, data collection procedures, and compliance requirements.
• Continuously assess and improve documentation and inter-departmental coordination processes to boost efficiency, accuracy, and results.
• Collaborate closely with healthcare providers, quality improvement teams, IT, and other departments to ensure smooth HEDIS® data collection and reporting.
• Ensure timely scheduling of meetings related to HEDIS®/Stars activities and timelines, providing necessary information and documents to facilitate focused discussions. Coordinate member and provider communications as needed.
• Adhere to payroll policies and use the time-keeping system correctly with minimal manual adjustments.
• Maintain consistent and regular attendance.
• Provide assistance to management with other assigned duties.
• Comply with the Compliance Plan and HIPAA regulations.

Marginal Job Functions

• Undertake related special projects as required.
• Support other teams to achieve associated QI goals when necessary.

Behavioral Expectations

• Continuous Learning: Attend staff meetings and relevant training, seminars, and workshops.
• Customer Focus: Maintain client/customer confidentiality and privacy in accordance with HIPAA regulations and IMAS’s Standards of Conduct. Foster appropriate communication and relationships with management, supervisors, colleagues, and other staff.
• Quality/Process Improvement/Safety: Promptly report security, health, or safety issues to the appropriate manager. Support and demonstrate safety in all duties. Follow established policies and procedures and comply with all regulatory standards set forth by governing entities.