Job Openings

HEDIS Manager

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Boston, MA
Job Type
Direct Hire
Jul 31, 2019
Job ID



Are you NCQA certified? Well-experienced with HEDIS reporting and quality improvement? Proficient retrieving, managing, analyzing, and reporting data? Have you coordinated medical records retrieval? Coordinated clinical staff training sessions on medical records review? Do you have any health plan experience? Have you assisted, led, or prepared the annual HEDIS roadmap for onsite audit? Have you finalized rates and actually submitted data to NCQA and CMS. If you have done these HEDIS management activities - please apply!


You will be responsible for overseeing annual HEDIS process, ensuring that all aspects of HEDIS implementation are timely and well-executed and that all HEDIS data is accurate. The HEDIS Manager will coordinate collection, submission and reporting of HEDIS data to NCQA to ensure HEDIS data accuracy and reporting.


  • Manage all aspects of the annual HEDIS submission, including but not limited to: preparing annual HEDIS road map for onsite audit; coordinating clinical staff training sessions on medical record review; retrieving medical records, as necessary abstracting and entering clinical data; coordinating QA of medical record review process; finalizing rates & submitting data to NCQA and CMS.
  • Manage the data collection and reporting of additional key quality reports as may be required by CMS and/or MassHealth.
  • Develop and maintains a detailed HEDIS project plan to include milestones, tasks, and target/actual dates of completion.
  • Prepare and submit project status reports to management as often as required.
  • Liaise with, and serve as key contact to external HEDIS vendors and auditors
  • Support the Director, Quality Analytics, Measurement & Reporting, before, during, and after the annual HEDIS audit to ensure all queries are addressed and appropriate actions taken.
  • Assure the timely submission of HEDIS data and supporting documentation to NCQA, MassHealth, CMS and others, as required by regulators.
  • Manage the HEDIS auditing process including the preparation of the HEDIS Roadmap and all other documents required by auditors.
  • Manage and ensure HEDIS medical record data abstraction and review is completed in a timely and accurate manner per NCQA specifications and supervise temporary medical record review personnel during HEDIS medical record data collection season.
  • Serve as team member for activities focused on HEDIS performance improvement.
  • On at least an annual basis, lead a cross-functional team through comprehensive assessment of the prior year’s data collection and reporting activities, identify opportunities for improvement in the efficiency and effectiveness of the activities, and recommend process improvements. 
  • Reports on key issues and insights regarding both the processes as well as the results of the medical record review metrics.


Minimum Education Required

  • Bachelor’s degree


Minimum Experience Required

  • Seven (7) or more years of relevant work experience with at least five years of progressive responsibility for NCQA HEDIS Health Plan reporting; oversight of the complete HEDIS data collection, analysis, and reporting processes.


Knowledge, Skills and Abilities

  • Comprehensive knowledge of all aspects of NCQA Health Plan HEDIS data collection and reporting requirements and processes.
  • In depth knowledge and experience overseeing, managing, and/or implementing health plan HEDIS data collection and reporting.
  • Experience working with one or more HEDIS data management and reporting vendors.
  • Experience and expertise in Health Plan quality data analysis, measurement, and reporting.
  • Highly skilled in managing large projects with multiple elements and expectations
  • Highly skilled in analytical reasoning and interpretation and evaluation of complex information and problems.
  • Ability to guide others in adhering to deadlines and meeting timeliness expectations.
  • Ability to work independently and as part of a team
  • Strong communication skills: oral and written
  • Computer skills: Microsoft Word; Excel; PowerPoint; and database software

We enjoy a company culture of passionate advocacy in a supportive work environment with opportunities for growth and learning, competitive salaries, and a generous and comprehensive benefit package.