- Humana (Phoenix, AZ)
- …demonstrate expertise and business intelligence in supporting execution of the HEDIS program and related activities, all within tightly regulated requirements and ... Compliance, and Risk Adjustment, as well as vended partners. The Senior HEDIS Operations & Quality Professional supports all aspects of the non-standard supplemental… more
- Molina Healthcare (Mesa, AZ)
- …Quality Reporting team. Designs and develops reporting solutions to assist HEDIS Outbound, Inbound extracts, Data Ingestions, Dashboards, Reports & Extracts for ... Experience** * 5+ Years of experience in working with ** HEDIS ** tools such as **Inovalon** or **ClaimSphere** * 5+...**ClaimSphere** * 5+ Years of experience in working with HEDIS Domain - such as Measure analysis/reconciliation on data… more
- Centene Corporation (Phoenix, AZ)
- …As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. **Position Purpose:** ... Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related to clinical initiatives such as health fairs and communicate with… more
- Molina Healthcare (Scottsdale, AZ)
- …Quality Analytics team. Designs and develops reporting solutions to assist HEDIS audit, rate tracking, and Identifying targeted Interventions and tracking outcome. ... tracking of progress and impact of such interventions. + Assist retrospective HEDIS rate tracking and supplemental data impact reporting. + Develop Medical Record… more
- Humana (Phoenix, AZ)
- …to drive the development of data products specifically related to CMS Stars and HEDIS quality measures. The ideal candidate has deep expertise in Stars/ HEDIS ... strategy, and roadmap for data products that enable CMS Stars and HEDIS reporting. Ensure alignment with enterprise goals and departmental priorities. + **Backlog… more
- Banner Health (AZ)
- …and assists with the analysis of data from medical records in accordance with HEDIS specifications. Actively works with the HEDIS team to ensure understanding of ... for accuracy with attention to detail. Knowledge and understanding of HEDIS specifications; Strong leadership skills (can construct a vision, thinks creatively… more
- Molina Healthcare (Tucson, AZ)
- …* Knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Knowledge of health care ... financial terms (eg, PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). * Demonstrated understanding of key managed care concepts and provider reimbursement principles such… more
- Molina Healthcare (AZ)
- …policy/procedure development, provider contracting experience. * Experience with NCQA, HEDIS , Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, ... capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines. To all current Molina employees: If you are interested in… more
- CenterWell (Phoenix, AZ)
- …**Superior patient/customer service** **Preferred** **Qualifications:** **Knowledge of HEDIS measures and quality indicators** **Experience managing Medicare ... Advantage panel of patients with understanding of Best Practice in coordinated care environment in a value-based relationship environment** **\#nursepractitionercareers** **\#physicianassistantcareers** Travel: While this is a remote position, occasional… more
- CenterWell (Phoenix, AZ)
- …telemedicine/telehealth . Knowledge of Medicare guidelines and coverage . Knowledge of HEDIS quality indicators . Experience working in value-based care settings . ... Experience working as a collaborating physician . Telehealth experience Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 1 **Pay Range** The compensation range… more