[Hiring] HEDIS Improvement Coordinator @COPE Health Solutions

Role Description

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.

Key Responsibilities

• Member Outreach & Care‑Gap Education
  • 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.
• Provider Outreach & Chart Retrieval Support
  • 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.
• HEDIS Season Operations
  • 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.
• Member Experience & Engagement
  • 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.
• Operational Support
  • 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.
• Cross‑Functional Collaboration
  • 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.

Qualifications

• 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.

Requirements

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

Competencies

• Clear and empathetic communication
• Persistence and follow‑through
• Strong documentation discipline
• Ability to manage high‑volume outreach
• Comfort navigating provider offices and workflows
• Team‑oriented and adaptable
• Detail‑focused and process‑driven

Benefits

• Comprehensive, affordable insurance plans for team members and their families.
• Yearly stipend for wellness-related activities.
• Paid parental leave program.