Quality Coordinator, HEDIS

Overview

The Quality Coordinator specializes in HEDIS (Healthcare Effectiveness Data and Information Set) and supports Quality initiatives for Champion. This position combines member outreach, care gap tracking, data analysis, reporting, and project coordination to support preventive care and quality improvement.

The coordinator assists members with scheduling care, coordinates with healthcare partners, obtains supporting medical records, and analyzes information to identify trends and opportunities for improvement. This onsite role includes in-person meetings with members, vendors, and providers as needed.

Essential Responsibilities

• Conduct member outreach by phone, email, in person, and other approved communication methods to support HEDIS and Quality initiatives.
• Assist members with scheduling preventive screenings, routine visits, and follow-up care appointments.
• Follow up on open care gaps and document outreach attempts, member responses, appointment status, and outcomes.
• Meet onsite with members, vendors, providers, and other healthcare partners to support Quality outreach and care gap initiatives.
• Coordinate with providers, medical groups, pharmacies, vendors, and internal departments to address outstanding care needs and obtain relevant information.
• Request, receive, and track medical records and supporting documentation related to HEDIS and care gap closure.
• Maintain accurate, complete, and timely outreach trackers, project records, and documentation in designated systems.
• Analyze Quality and outreach data to identify trends, gaps in care, and opportunities for quality improvement.
• Prepare detailed reports and status summaries for leadership review, verifying data accuracy and identifying findings that require follow-up.
• Support project management by coordinating timelines, tracking milestones and progress, and communicating outstanding tasks or delays.
• Support adherence to applicable accreditation standards by maintaining required documentation, tracking assigned requirements, and escalating potential deficiencies.
• Identify barriers to care, including transportation, language, scheduling, and access concerns, and escalate issues appropriately.
• Refer clinical questions or concerns to qualified clinical staff.
• Follow established procedures and instructions, seek clarification when needed, and complete assignments accurately within established deadlines.
• Participate in training and apply new procedures, systems, and job-related information.
• Manage multiple assignments and meet established quality and productivity expectations.
• Protect confidential member information and follow Champion’s privacy, security, and approved communication procedures.
• Perform other related duties as assigned.

Required Qualifications

• Strong verbal and written communication skills and a professional, respectful approach to interacting with members and healthcare partners.
• Strong organization, attention to detail, and follow-up skills.
• Ability to review and analyze data, identify trends or discrepancies, and prepare clear reports.
• Ability to coordinate project timelines, track progress, and communicate priorities and outstanding tasks.
• Working proficiency with Excel, including maintaining trackers, organizing data, and preparing summaries.
• Comfort working with SharePoint, electronic health records (EHRs), and healthcare reporting systems.
• Ability to accurately enter, maintain, and review information across multiple systems.
• Ability to follow verbal and written instructions, seek clarification when needed, and complete assigned tasks accurately within established deadlines.
• Ability to learn and apply new procedures, systems, and job-related information within established training periods, with appropriate training and support.
• Ability to manage assigned responsibilities, maintain consistent follow-through, and meet established quality and productivity expectations.
• Demonstrate reliability and punctuality in meeting scheduled work hours, member appointments, and business commitments, subject to applicable protected leave and reasonable accommodations.
• Ability to work independently and collaboratively while handling confidential information appropriately.
• Ability to perform the essential functions of the position, including onsite duties and in-person meetings with members, vendors, and providers, with or without reasonable accommodation.

Preferred Qualifications

• 2+ years of Medical Assistant experience.
• Basic knowledge of HEDIS measures, preventive screenings, and care gaps.
• 3+ years of experience in healthcare quality improvement, member outreach, appointment scheduling, or medical record retrieval.
• Experience with healthcare data analysis, reporting, or project coordination.
• Familiarity with health plan accreditation standards and related documentation.
• Experience working in a health plan, medical group, provider office, or other healthcare setting.
• Familiarity with Medicare Advantage populations.
• Bilingual skills English/Spanish.

Equal Employment Opportunity

Champion Payer Solutions, LLC is an equal opportunity employer and makes employment decisions without unlawful discrimination based on any characteristic protected by applicable federal, state, or local law.

Pay: From $24.00 per hour

Expected hours: 40.0 per week

Benefits:

• 401(k)
• AD&D insurance
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person