HEDIS Improvement Coordinator

COPE Health Solutions

6d•$25•Remote

About The Position

This role focuses on educating members about care gaps, assisting with appointment scheduling, supporting medical record retrieval, and providing operational support to the HEDIS Lead and Quality Improvement Manager. The Coordinator plays a key role in improving clinical outcomes, documentation completeness, and member engagement for the Medicare Advantage population.

Requirements

High school diploma or equivalent; associate degree preferred.
1–2 years of experience in healthcare, customer service, call center operations, or medical office support.
Strong communication skills and comfort speaking with members and provider staff.
Basic understanding of preventive care, chronic conditions, and healthcare terminology.
Proficiency with Microsoft Excel and ability to learn new systems quickly.
Strong organizational skills and attention to detail.

Nice To Haves

Experience in managed care, Medicare Advantage, or HEDIS operations.
Prior experience with member outreach, appointment scheduling, or medical record retrieval.
Familiarity with EMRs, chart retrieval platforms, or care‑gap reporting tools.
Bilingual skills (Spanish, Mandarin, etc.) helpful but not required.

Responsibilities

Conduct outbound calls to members to educate them on open care gaps (e.g., screenings, chronic condition monitoring, immunizations).
Assist members with scheduling preventive and follow‑up appointments with their primary care provider or specialist.
Provide reminders, instructions, and follow‑up support to ensure members complete recommended services.
Document all outreach attempts, outcomes, and barriers in the appropriate systems.
Contact provider offices to request medical records needed for HEDIS hybrid measures.
Coordinate chart retrieval logistics, including fax requests, EMR access, secure email, and vendor retrieval scheduling.
Track provider responses, escalate non‑responsive offices, and ensure timely completion of retrieval tasks.
Maintain organized logs of outreach attempts, record status, and documentation received.
Support the HEDIS Lead with chase list management, outreach prioritization, and data entry.
Assist with basic chart review tasks such as confirming documentation presence, verifying dates of service, or flagging incomplete records (non‑clinical abstraction).
Monitor daily progress toward retrieval and outreach targets and report barriers or delays.
Provide clear, empathetic communication to members regarding preventive care, chronic condition management, and the importance of screenings.
Identify and document member‑reported barriers to care (transportation, access issues, appointment availability) and escalate as appropriate.
Support CAHPS‑related initiatives through member education and service navigation.
Maintain accurate, audit‑ready documentation of all outreach activities, provider interactions, and record retrieval efforts.
Assist with preparing materials for Stars workgroups, HEDIS meetings, and quality committees.
Support the development of outreach scripts, workflows, and process improvements.
Work closely with the HEDIS Lead, Quality Improvement Specialist, Care Management, Provider Relations, and vendor partners.
Communicate provider issues, member barriers, and operational challenges to the HEDIS Lead for resolution.
Participate in training sessions, huddles, and performance review meetings during HEDIS season.