P3 Health Partners · 6 hours ago
National Quality HEDIS Data Program Specialist
Omaha, NE
Full-time
Onsite
Mid, Senior Level
$100K/yr - $115K/yr
5+ years expP3 Health Partners is a physician-led organization focused on transforming healthcare into wellness guidance. They are seeking a HEDIS Data Program Specialist to manage the HEDIS reporting process, ensuring clinical quality and outcomes meet established standards, while also facilitating quality improvement initiatives across the organization.
FinanceFinancial ServicesHealth CareHospitalMedical DeviceVenture Capital
Responsibilities
Generating reports on HEDIS performance, identifying trends, and presenting findings to department and executive leadership for decision-making
Ensure data accuracy and calculated scoring
Reports include Monthly Stars Dashboard, QM productivity reports, HealthPlan Reconciliation, and NQUC presentations
Coordinate with clinical staff to inform them of missing screenings and HEDIS gaps
Download patient records and upload them to insurance portals to close quality gaps
Collecting, reviewing, and analyzing standard and non-standard data extracts for HEDIS gap closures
Ensuring Affiliate Provider EMR Files are received and loaded along with ensuring expected gap closures are reflected in QM system
Review ACO internal QM data and reconcile with CMS files
Identify new digital HEDIS data capture opportunities and gap closure strategies
Assist with provider EMR data collection and/or data extract set-up
Collaborating with market Provider Engagement Teams to ensure accurate gaps in care are presented on provider reports
Reconciliation with Health Plans, GIC files, and Health Plan EMR files
Coordinating with external auditors to ensure readiness for HEDIS audits and address any identified issues
QM Liaison with Analytics to identify and correct data errors found
Managing various vendors across markets ensuring data sharing gaps, monitoring productivity and closure metrics
Responsible for sending and receiving weekly/monthly vendor quality worklists and sharing results with markets
Staying updated on NCQA HEDIS guidelines and adherence to health plan regulatory requirements
Qualification
Required
Bachelor's degree in a related field, master's preferred
Minimum of 5 years experience with data analysis
Minimum of 3 years in a healthcare environment
Experience with HEDIS Technical Specifications, guidelines, reporting and HEDIS survey process
Experience in Project Management
Experience utilizing various software packages including SharePoint, Excel, Access, PowerPoint and Word
Extensive Excel skill required; SQL skills preferred
Knowledge of HEDIS Quality Management Measure Specifications
Knowledge of federal, national, state, and health plan regulatory requirements, as well as managed care and health plan standards
Knowledge of the CMS Star Rating or MIPS, MACRA, or a federal incentive-based program
Strong analytical and critical thinking skills
Ability to learn and adapt to multiple technology platforms
Excellent communication and collaboration skills to work with health plans and internal teams
Project management skills to manage data discrepancies and complex quality improvement initiatives
Able to think and work effectively under pressure
Ability to function effectively within multidisciplinary teams
Ability to effectively prioritize multiple tasks and deadlines and accurately complete tasks within established times
Knowledge of medical terminology and coding (ICD-10, CPT, CPTII, LOINC, SNOMED)
Goal-oriented, self-motivated, organized, team player, problem solver, etc
Aware of HIPAA rules regarding patient health information security
Ability to meet and manage deadlines
Preferred
SQL skills preferred
Company
P3 Health Partners
P3 Health Partners is a patient-centered, physician-led and population health-focused healthcare company.
201-500 employees
Funding
Current Stage
Public CompanyTotal Funding
$332.2MKey Investors
Chicago Pacific FoundersChicago Pacific Founders,Leavitt Partners
2024-05-23Post Ipo Equity· $42.2M
2023-03-31Post Ipo Equity· $90M
2021-12-06Post Ipo Equity· $200M
Leadership Team
Sherif Abdou
Co-Founder
Bill Bettermann
Chief Operating Officer
Recent News
2025-12-02
2025-11-14
Company data provided by crunchbase