Summary:
The HEDIS Coordinator plays a critical role in driving quality outcomes by partnering with Primary Care Physician (PCP) offices, health plan partners, and internal teams to improve compliance with NCQA HEDIS measures—specifically diabetic eye exam completion. This role serves as the primary liaison for coordinating tele-retinal screenings, managing outreach initiatives, and supporting provider offices to ensure successful program execution.
The HEDIS Coordinator is responsible for validating member eligibility, managing non-compliant patient lists, and coordinating schedules for screening technicians to facilitate timely services. Through continuous collaboration, training, and support of provider office staff, this role ensures efficient workflows and strong engagement with program requirements. The coordinator also conducts member outreach, assists with appointment scheduling, and leverages data analysis to track performance and inform decision-making.
Success in this role requires strong organizational, communication, and analytical skills, along with the ability to manage multiple priorities and identify opportunities for process improvement in a dynamic healthcare environment.
Duties & Responsibilities:
· Responsible for working directly with Primary Care Physician (PCP) offices to ensure their non-compliant diabetic members receive their annual diabetic eye exam to fulfil the NCQA HEDIS quality measure
· Work as the main point of contact for PCP offices to coordinate successful on-site tele-retinal diabetic screenings and member outreach efforts
· Validate member eligibility for services using Alivi Health platforms
· Perform initial training and ongoing support for point of contact at PCP offices
· Manage and validate non-compliant patient lists sent from health plan partners as well as PCP offices
· Coordinate the schedule of HEDIS Technicians for tele-retinal diabetic screenings
· Collaborate with team members and management, as well as screening location staff, to form appropriate action plans to meet the client's needs
· Capture and analyze data to drive informed outcomes
· Provide outreach to members and assist in the scheduling of appointments with vision providers
· Work with business partners to identify process improvements and perform other duties as assigned by management
Requirements & Qualifications:
· Two to four years of experience in Vision Care or healthcare
· Demonstrated ability to build and maintain strong relationships with internal stakeholders and external provider partners
· Excellent interpersonal skills, with the ability to take initiative and work both independently and collaboratively
· Strong organizational skills with exceptional time management and attention to detail
· Ability to manage multiple priorities simultaneously and adapt in a fast-paced, evolving environment
· Proficiency in Microsoft Word, Excel, and Outlook, with the ability to quickly learn Alivi Health systems and tools
Pay: $21.00 - $25.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Health savings account
- Paid time off
- Vision insurance
Application Question(s):
- Have you worked with NCQA HEDIS measures? If yes, which measures?
- Which EMR/EHR systems have you used?
- This role requires managing multiple provider offices, member outreach activities, and scheduling simultaneously. Are you comfortable working in a fast-paced environment?
- Have you worked with Medicare Advantage or Medicaid populations?
- Have you coordinated care gaps or preventive care initiatives?
Experience:
- Healthcare or Vision: 2 years (Required)
Work Location: In person
