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HEDIS Specialist in Long Beach, CA at Pionear

Date Posted: 11/29/2018

Job Snapshot

Job Description

A large Managed Care Company in the Long Beach area is currently hiring for HEDIS Specialist roles. We are looking for professional candidates with appropriate experience who can be available same day or next day for assignments at any given time.


  • Under the direction of the HEDIS Program Manager, supports the annual HEDIS project management by coordinating the identification, collection and abstraction of medical records and other data in collaboration with other HEDIS staff
  • Assists the Manager in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review
  • Participates in meetings with vendors for the medical record collection process. Assists Manager with medical record vendor oversight
  • Assists Manager in training abstractor staff and participates in the medical record IRR
  • Identifies member service gaps based on data loaded in the MHI HEDIS application
  • Collects medical records and reports from provider offices based on member needed services reports and gaps and loads data into the HEDIS application
  • Works with the corporate HEDIS team to monitor accuracy of abstracted records as required by HEDIS specifications
  • Participates in scheduled meetings with the corporate HEDIS team, vendors and HEDIS auditors
  • Assists the QI staff with physician and member interventions and incentive efforts as needed
  • Provides data collection and report development support for Quality Improvement studies and performance improvement projects
  • Assists as needed in support of accreditation activities such as NCQA reviews, CAHPS and state audits

Job Requirements


  • Proficient with PC-based systems and the ability to learn new information systems and software programs 
  • Ability to work with large files and data sets 
  • Basic understanding of Health Plan billing practices and information systems 
  • Strong communication and teaming/interpersonal skills; strong leadership capabilities 
  • Ability to initiate and maintain cross-team relationships 
  • Excellent verbal and written communication skills
  • Maintain regular attendance based on agreed-upon schedule 
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) 
  • Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

Required Education:

  • State Licensed Vocational Nurse or Registered Health Information Technician (RHIT), or Certified Medical Record Technician with training in coding procedures

Required Experience:

  • 0-2 years coding and medical record abstraction experience
  • 0-2 years managed care experience
  • Basic knowledge of HEDIS and NCQA

Required Licensure/Certification:

  • Licensed LVN/LPN, Registered Health Information Technician (RHIT), or Certified Medical Record Technicians

Pionear is an equal opportunity employer