HEDIS Quality Coordinator - CBO TCHP Ambulatory Quality - Full Time - Days

The purpose of this position is to support the health network’s quality and performance goals, with a focus on achieving a 5-star rating for performance in value-based care contracts and our accountable care organization (ACO). This includes conducting outbound calls to members to previsit plan and close HEDIS gaps in care, discussing the importance of early detection and disease prevention. Will be contacting medical offices to coordinate appointments and facilitate necessary services to support patient health and mitigate any future issues. The role will also require ongoing communication and collaboration with the internal and external healthcare providers, office staff, and the payer partner liaison team.

EDUCATION: High school graduate required. Relevant Associates degree and/or equivalent health care experience preferred; Bachelors degree a plus.

YEARS OF EXPERIENCE:

Minimum of 2+ years of experience in a healthcare or payer setting, with a focus on patient outreach, customer service or care coordination is required. Experience with member or patient outreach, customer service, or care coordination strongly preferred.

REQUIRED SKILLS AND KNOWLEDGE:

- Knowledge of HEDIS measures, Commercial, Medicare, Medicaid quality programs and quality measure adherence is preferred.

- Previous patient care experience is a plus.

- Excellent verbal communication and interpersonal skills, with the ability to educate, motivate, and problem-solve over the phone.

- Comfortable making high-volume outbound calls to members, providers, and payers.

- Proficient in Microsoft Office, specifically Excel and experienced with healthcare data systems or EMRs. Epic experience is a plus.

- Basic analytical skills, including experience working with spreadsheets (Excel or similar), and the ability to interpret and organize data effectively.

- Strong attention to detail, time management, and the ability to work both independently and as part of a cross-functional team.

- Commitment to maintaining confidentiality and complying with HIPAA and organizational standards.

- Bilingual in English/Spanish is a plus.