Duties & Responsibilities:

• Interacts with hospitals, providers, and members to improve quality of care, monitor progress, and recommend changes

• Reviews billing codes, medical records, and claims submission processes to ensure accuracy

• Attends and facilitates any initiative meetings (studies, partnerships) that involve targeted providers and/or measures

• Completes on-site provider visits to implement work plans and conduct provider education sessions regarding appropriate coding practices and chart documentation

• Collaborates with other departments to maximize member outreach for preventive services and chronic disease management

• Assists in writing member and/or provider articles on HEDIS, QARR, Medicare Advantage, and/or health promotions for the HF newsletter

• Assists and supports regulatory affairs

• Document all relevant interactions in appropriate systems

• Additional duties as necessary

Minimum Qualifications:

• Associates degree from an accredited institution

• Ability to travel around the NYC metro area

Preferred Qualifications:

• Bachelors Degree from an accredited institution

• Clinical license: LPN, RN, LMSW or LCSW

• Multiple years of HEDIS review experience for both Medicaid and Medicare lines of business

• Medical record review experience directly working on HEDIS/QARR in a managed care setting

• Good presentation, relationship management, and analytical skills

• Intermediate MS Word, Excel, and PowerPoint

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.