Job Description

Job Title: Quality Improvement Specialist (HEDIS)
Location: Onsite Columbus, Ohio, 43219 (Daily commute required)
Assignment Duration: 4 months

Work Schedule

• Standard 8-hour workday
• Start time: 8:00 AM (0.5 1 hour lunch)
• Flexibility available with prior approval

Position Summary

The Quality Improvement Specialist (HEDIS) supports quality improvement initiatives focused on HEDIS Hybrid Operations. This role provides clinical and operational support for medical record review, abstraction, over-read, and audit activities. The position plays a key role in identifying care gaps, supporting quality metric performance, and contributing to annual HEDIS chart chase activities.

Key Responsibilities

• Support HEDIS hybrid medical record abstraction, over-read, and audit processes.
• Provide clinical guidance and quality oversight during chart review activities.
• Train providers, health plan staff, and internal teams on HEDIS methodologies, abstraction standards, and quality improvement tools.
• Monitor performance against established quality indicators and contractual benchmarks.
• Analyze, track, and trend quality data to identify improvement opportunities.
• Recommend, develop, and support quality performance improvement plans (PIPs) using the PDSA model.
• Monitor and report progress of PIPs through completion.
• Participate in meetings with internal teams, providers, vendors, and external stakeholders.
• Maintain compliance with organizational policies, procedures, and quality standards.
• Perform additional quality-related duties as assigned.

Typical Day in the Role

• Review and support medical record abstraction and quality review workflows.
• Collaborate closely with abstractors, over-readers, auditors, and leadership staff.
• Track productivity metrics and quality indicators aligned with permanent staff benchmarks.
• Participate in scheduled and ad-hoc team meetings.
• Work onsite in a structured, collaborative office environment.

Education & Experience

Preferred:

• Bachelor's degree in Nursing, Healthcare, Quality, or a related field
• Experience with HEDIS, NCQA standards, or quality improvement programs
• Clinical background (RN, LPN, or similar) preferred but not required

Required:

• Demonstrated experience in quality improvement, HEDIS operations, or medical record review
• Proficiency in Microsoft Excel (sorting, filtering, formatting, basic formulas, and simple visualizations)

Required Skills & Competencies

• Strong attention to detail and data accuracy
• Ability to work with fax machines and document scanners
• Basic to intermediate Excel skills
• Analytical thinking and problem-solving abilities
• Effective verbal and written communication skills
• Ability to collaborate in a fast-paced, metrics-driven environment

Performance Expectations

• Meet established daily productivity and quality benchmarks for record requests, intake, abstractions, and assigned tasks.
• Maintain accuracy and compliance consistent with permanent staff standards.

Work Environment

• Onsite office setting
• Collaborative team environment with regular interaction across quality and clinical teams
• Structured schedule with defined productivity expectations

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