Quality​/HEDIS Coordinator

Doctors Health Care Plans is a Medicare Advantage health plan serving South and Central Florida. The HEDIS Coordinator supports the organization's HEDIS and CMS Star Ratings initiatives by coordinating medical record retrieval activities, conducting chart reviews, maintaining provider relationships, presenting performance data, and leading provider-focused quality improvement efforts.

This position serves as the primary quality liaison for assigned provider groups and is responsible for collaborating with providers, office staff, and internal stakeholders to improve HEDIS performance, close gaps in care, enhance documentation practices, and support overall Star Ratings performance.

This is a field-based position requiring regular travel throughout Miami-Dade and Broward Counties. The ideal candidate is comfortable working independently, leading provider meetings, presenting performance data, facilitating quality improvement discussions, and building strong relationships with physicians and provider office staff.

• Contact provider offices to request medical records and coordinate onsite or remote retrieval activities.
• Retrieve medical records through provider office visits, EMR systems, secure portals, fax, or other approved methods.
• Upload, organize, and maintain medical records within designated company repositories and tracking systems.
• Maintain accurate documentation of records requested, received, reviewed, pending, and completed.
• Monitor and follow up on outstanding record requests to ensure project deadlines are met.
• Ensure timely completion of medical record collection activities in support of HEDIS and quality initiatives.
• Maintain familiarity with annual HEDIS measure specifications, CMS Star Ratings requirements, and documentation standards.

• Perform medical record reviews to identify documentation supporting HEDIS measures and quality initiatives.
• Identify open gaps in care, missing documentation, and opportunities for performance improvement.
• Assist with validating medical record completeness and supporting audit readiness efforts.

• Serve as the primary Quality/HEDIS point of contact for assigned provider groups.
• Develop and maintain strong working relationships with physicians, provider office leadership, clinical staff, and administrative personnel.
• Schedule, coordinate, and lead quality meetings with assigned provider groups and internal stakeholders.
• Present provider scorecards, quality reports, HEDIS performance results, open gaps in care, Star Ratings measures, and performance trends.
• Facilitate discussions with providers and office staff regarding barriers to performance improvement and strategies to improve measure compliance.
• Conduct provider education regarding HEDIS measures, CMS Star Ratings requirements, clinical documentation standards, and annual measure updates.
• Monitor provider progress toward quality goals and follow up on action items identified during meetings.
• Document meeting outcomes, recommendations, action plans, and provider commitments.
• Assist providers with understanding scorecards, gap lists, quality reports, and performance improvement opportunities.
• Support provider engagement initiatives designed to improve quality performance, clinical outcomes, and CMS Star Ratings results.

• Maintain HEDIS tracking logs, provider engagement records, retrieval status reports, and quality improvement documentation.
• Assist with monitoring provider performance and reporting project status to leadership.
• Validate provider contact information, office locations, HEDIS contacts, and retrieval methods.
• Prepare reports, summaries, presentations, and supporting documentation for provider meetings and quality initiatives.
• Ensure documentation is maintained according to organizational policies and regulatory requirements.

• Maintain strict confidentiality of member and provider information.
• Comply with HIPAA, CMS, AAAHC, organizational policies, and all applicable regulatory requirements.
• Ensure proper handling, storage, transmission, and protection of protected health information (PHI).
• Adhere to departmental procedures for record management, quality reporting, and provider engagement activities.

• High school diploma or equivalent.
• Bilingual in English and Spanish.
• Minimum of 2 years of experience in…