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HEDIS Specialist in Orange at Prospect Medical Systems

Date Posted: 3/14/2019

Job Snapshot

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Job Description

HEDIS Specialist

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The HEDIS Specialist is responsible for the Coordination of P4P Self Reporting Audit, roadmap preparation, data collection and reporting processes in addition to HEDIS intervention activities to improve related clinical performance measures for the commercial and Medi-Cal lines of business. Additionally, this position will take a lead role in coordinating the efforts to improve and is responsible for coordination activities related to the HEDIS and IHA measures. Serves as the liaison with Network Management, Medical Management, IT and other ad hoc departments and programs as necessary.

Job Responsibilities/Duties

  • Coordinate completion of IHA and HEDIS roadmaps.  
  • Provide timely measure status reporting, including trending and analyzing of the data
  • Create ad-hoc reports to assist with the tracking of the P4P and HEDIS measures
  • Develop and respond to P4P and HEDIS Audit Corrective Action Plan (CAP) as necessary
  • Develop and maintain the P4P and HEDIS training manual and documentation in accordance with department standards, including industry best practices
  • Collect medical records and reports from provider offices based on member-needed services reports and gaps, and load data into the HEDIS application.
  • Assist the Quality Care Coordinators with physician and member interventions and incentive efforts as needed.
  • Provide data collection and report development support for Quality Improvement studies and performance improvement projects.


Minimum Education: High School graduate required; Associate in Arts degree preferred.

Minimum Experience: A minimum of three (3) to four (4) years of IPA/HMO experience in P4P/HEDIS Programs. Advanced in Microsoft Office Excel and proficient in Microsoft applications

Req. Certification/Licensure: None

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  •  Medical, dental, vision insurance
  •  Paid time-off
  • Life insurance

How to Apply

To apply for this role, or search our other openings, please visit  and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

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