Experienced Clinical HEDIS Manager for Healthcare Data Analytics and Quality Improvement Initiatives

Join Reveleer, a Pioneer in Healthcare Data Analytics, as a Clinical HEDIS Manager Reveleer is revolutionizing the healthcare industry with its cutting-edge data analytics and Artificial Intelligence (AI) solutions, empowering health plans to enhance their Quality Improvement, Risk Adjustment, and Member Management programs. As a leader in the healthcare technology sector, Reveleer is seeking a seasoned Clinical HEDIS Manager to oversee the critical tasks of HEDIS abstracting and reporting, as well as manage RISK projects as needed. About Reveleer and the Role At Reveleer, we're committed to delivering transformative solutions that enable health plans to independently execute and manage every aspect of enrollment, provider outreach, data retrieval, coding, abstraction, reporting, and submissions. With our proprietary technology, robust data sets, and subject matter expertise, we provide comprehensive record retrieval and review services. As a Clinical HEDIS Manager, you will play a pivotal role in ensuring the accuracy and quality of medical record reviews for HEDIS measures, supporting process and quality improvement initiatives, and serving as a subject matter expert (SME) for HEDIS. Key Responsibilities Oversee and/or perform accurate medical record reviews for all HEDIS measures, ensuring compliance with NCQA HEDIS abstracting guidelines. Support and participate in process and quality improvement initiatives to enhance operational efficiency and data quality. Conduct training sessions related to HEDIS measures and platform usage, updating training materials as necessary, and serve as a HEDIS SME. Monitor project status, working on flexible projects with variable client/project-specific guidelines. Review and facilitate Inter-Rater Reliability (IRR) reviews, as well as review all Negative/Positive hits to ensure accuracy. Manage RISK coding projects when needed, including project status monitoring and completing chart reviews for coding projects as required. Analyze medical records and NLP results to validate clinical evidence meets necessary requirements for submission and documentation. Ensure documentation aligns with accurate code assignment, following CMS's coding guidelines for HCC risk adjustment coding. Maintain a deep understanding of medical terminology, disease processes, treatments, and procedures to accurately interpret and validate clinical documentation. Safeguard the integrity and confidentiality of patient health information, handling medical records and sensitive data in accordance with HIPAA and other relevant regulations. Foster clear communication and collaboration between different healthcare departments, ensuring accurate patient information is shared across the continuum. Essential and Preferred Qualifications To excel in this role, you must possess: A professional coding certificate through AHIMA/AAPC. A minimum of 5 years of hands-on medical records experience and 5 years of HEDIS experience. Knowledge of NCQA HEDIS abstracting guidelines is highly preferred. A valid nursing license (RN/LPN) is preferred. Background in Utilization Review (UR), Quality Assurance (QA), and/or Quality Improvement (QI) experience is preferred. Strong computer skills and high-speed internet access at home. A commitment to confidentiality of patient health information. Professional, articulate, and able to work independently, with the ability to manage teams and meet deadlines. Core Competencies and Skills The ideal candidate will demonstrate the following core competencies: Caring: Warm, sincere, calm, cool, and collected energy and presence, with the ability to develop relationships. Results Driven: Focus on achievement, motivated by results and outcomes, goal-oriented. Analytical Skills and Attention to Detail: Reviewing clinical documentation and coding with precision. Effectively Communicates: Speaks clearly, listens effectively, and responds well to questions; writes clearly and informatively. Problem Solver: Expertise in managing client relationships and accounts for technically complex products and platforms. Continuous Quality Improvement: Evaluates policies, programs, and services, implementing strategies for continuous quality improvement. Customer Focus: Follows through, courteous, helps internal and external customers, understands customer perspectives and needs. Interpersonal Skills: Builds strong relationships, flexible and open-minded, receptive to feedback. Professionalism: Approaches others in a tactful manner, reacts well under pressure, treats others with respect and consideration. Adaptability: Adapts to changes in the work environment, adjusts methods to best fit the situation. Cultural Sensitivity: Models behaviors that reflect the culture of Reveleer, awareness of the similarities and differences that exist between employees, teams, departments, and customers. Career Growth Opportunities and Learning Benefits At Reveleer, you will have the opportunity to grow professionally in a dynamic and innovative environment. As a Clinical HEDIS Manager, you will be exposed to various aspects of healthcare data analytics and quality improvement, enhancing your skills and knowledge in HEDIS abstracting, reporting, and RISK project management. Our commitment to continuous quality improvement and customer focus will help you develop a deeper understanding of the healthcare industry and stay up-to-date with the latest trends and best practices. Work Environment and Company Culture Reveleer is an equal opportunity employer that values diversity and promotes an inclusive culture. As a remote organization, we offer the flexibility to work from anywhere, provided you have a stable high-speed internet connection. Our compensation package reflects the cost of labor across several US geographic markets, and we offer a competitive salary range of $100,000 - $115,000 annually, based on job-related knowledge, skills, and experience. Compensation, Perks, and Benefits While specific details about our benefits package are not listed here, we are committed to providing a comprehensive compensation and benefits package that supports the well-being and financial security of our employees. We E-Verify all new hires and are committed to compliance with applicable federal, state, and local laws regarding equal employment opportunities. Join Our Team If you're a motivated and experienced Clinical HEDIS Manager looking to make a meaningful impact in the healthcare industry, we encourage you to apply for this exciting opportunity. At Reveleer, we're passionate about harnessing the power of data analytics and AI to improve healthcare outcomes. As a Clinical HEDIS Manager, you will be an integral part of our team, driving quality improvement initiatives and ensuring the accuracy and integrity of medical record reviews. Apply now to join our dynamic team and contribute to our mission of delivering more value and improved outcomes in healthcare. Apply for this job