HEDIS / STARS Representative

POSITION SUMMARY

The HEDIS Representative plays a vital role in supporting the administrative and operational functions within a healthcare organization. This position focuses on tasks related to member account coordination, patient access, and overall support services. The ideal candidate will help ensure efficient workflows, maintain accurate records, and contribute to a positive, patient-centered care experience. This role is essential to improving quality performance, supporting HEDIS and Stars initiatives, and enhancing overall member satisfaction.

Position is onsite Monday-Friday.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Provide excellent customer service by addressing patients and client needs promptly and courteously
• Phone calls to patients for scheduling or education on HEDIS Measures.
• Review medical records for data collection, data entry, and quality monitoring including chart collection activities that close gaps in care.
• Provide support to internal departments regarding quality improvement activities.
• Maintains education/knowledge base of HEDIS/Stars.
• Perform all other related duties as assigned.

QUALIFICATIONS AND EDUCATION

Required qualifications:

• Bilingual English & Spanish or Creole.
• High school diploma or equivalent is required.
• Two (2) or more years of experience in reviewing medical records for data collection, data entry that close gaps in care.
• Two (2) or more years of experience working with HEDIS/STAR measures.
• Two (2) or more years of experience in an administrative role, Client Account Administrator, or Patient Access Representative.
• Two (2) or more years of proficient experience using electronic medical record (EMR) systems and other healthcare management software.
• Collaborate with physicians, clinical staff, and other healthcare professionals to meet HEDIS performance measures.
• Ability to handle sensitive information with confidentiality and professionalism.
• Excellent verbal communication skills with a customer-focused approach.

Preferred qualifications:

• Two (2) or more years of college, in pursuance of a Bachelor's or Associate's degree in Health Care.
• Licensed Vocational/Registered Nurse, Certified Professional Coder, or Foreign Medical Graduate (FMG/IMG).
• Certification in medical coding, billing, or healthcare administration is a plus.
• Proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook)

WORKING CONDITIONS

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The noise level in the work environment is usually moderate.
• Fast-paced office environment.
• Highly regulated environment.
• Interacts with patients, family members, staff, visitors, government agencies, etc, under a variety of conditions and circumstances.

This work requires the following physical activities: climbing, bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed indoors. Sits, stands, bends, lifts, and moves intermittently during working hours. May be sitting for a prolonged period.

The work schedule is approximate, and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including weekends and holidays as needed. May require some OT during varying seasons of the year.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The employee must be able to frequently lift up to 10 pounds and occasionally lift and/or move up to 25 pounds. While performing the duties of this job, the employee is regularly required to talk or listen. The employee is frequently required to stand and walk. The employee is occasionally required to use hands to finger, handle, or feel; reach with hands and arms; climb or balance and stoop, kneel, crouch, or crawl. Specific vision abilities required for this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

PERFORMANCE MEASUREMENTS

• Duties accomplished at the end of the day/month.
• Attendance/punctuality.
• Compliance with Company regulations.
• Safety and Security.
• Quality of work.

This Job Description may be modified at any time at the discretion of the employer as business operations may deem necessary. This does not constitute an employment agreement and may not include all duties.

The above statements are intended to describe the general nature and level of work performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel classified. The incumbent must be able to work in a fast-paced environment with a demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate.