HEDIS Coordinator

Spectraforce Technologies
United States, Tennessee, Nashville
Oct 09, 2025
Position Title: HEDIS Coordinator Work Location: Remote Assignment Duration: 6 Months Work Schedule: 8 hours Position Summary: Perform duties to ensure HEDIS data accuracy and reporting, including investigation, auditing, and improvement opportunities. Assist with quality improvement initiatives in the service and clinical areas. Background & Context: Needing a HEDIS Specialist to assist with record review and auditing through Q4 and into HEDIS Hybrid project. Our drive to is to reach the highest star rating for our plan. Must have HEDIS experience and HEDIS measure knowledge. Previous experience required. Any knowledge of QMRM and QCAT a bonus. Key Responsibilities: Coordinate, complete, and update management on clinical quality metrics and HEDIS processes and results Establish and maintain an action plan to improve HEDIS scores Implement process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities Collaborate with providers and internal departments on rate investigation and validation activities, including maintaining all evidences, documentations, and changes Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality Qualification & Experience: Bachelor's degree in related field or equivalent experience. 3+ years of quality improvement or healthcare related experience. Working knowledge of the National Committee on Quality Assurance (NCQA). HEDIS requirements preferred. For the Nevada region only: Driver's license required. For federal services only: Government Security/Clearance/US Citizenship Requirements Typical Day in the Role: 8 hour days, no OT. Review 40-80 medical records for compliance and submit for HEDIS gap closure. Covers Medicaid, Medicare and Marketplace LOB. Will be fully integrated with other HEDIS staff. Work is remote. Must be driven and have a strong work ethic. Compelling Story & Candidate Value Proposition: Satisfaction of knowing our members are being taken care of by providers. Very strong team already in place with a great team collaboration environment. Candidate Requirements: Education/Certification Required: Bachelor's Degree Preferred: Licensure Required: Preferred: Years of experience required / Disqualifiers / Performance indicators Must haves: Strong HEDIS knowledge, including measure knowledge Nice to haves: Experience with QMRM/Inovalon and QCAT programs Disqualifiers: No HEDIS or measure knowledge Performance indicators: Strong work ethic. Must maintain a approval rate of 95% or higher for medical record reviews Top 3 must-have hard skills (stack-ranked) Strong HEDIS skills and Work Ethic At least 3 years experience with HEDIS Ability to work in a remote environment and complete set goals to drive results