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HEDIS Coordinator Career Guide

Do you have solid computer skills? Are you organized, able to keep accurate records, and have an interest in healthcare? Pursuing a career as a HEDIS coordinator could be the perfect opportunity for your future.

HEDIS coordinators work with HEDIS (Healthcare Effectiveness Data and Information Set) to review and analyze the performance of different medical care and services. They evaluate metrics to ensure that the quality of services is maintained. Analyzing HEDIS data helps HEDIS coordinators to find opportunities for improvement in medical care. 

HEDIS coordinators need to be knowledgeable on HEDIS processes as they maintain data, review reports, and update changes. They strategize on how to improve HEDIS scores. They need to have good communication skills to work with providers and other stakeholders to validate activities. Good leadership qualities are important. HEDIS coordinators work in physician’s offices, or other health care and wellness facilities.

Sample job description

[Your Company Name] is looking for an experienced HEDIS coordinator! If you have previous experience working with the healthcare effectiveness data and information set or are a quick learner with previous experience in the healthcare field, we want you! Your job will be to accurately assess, record, and parse the information presented by the HEDIS system. You will also be required to coordinate the HEDIS process and establish successful methods by which to determine the performance and success of medical treatments. A bachelor’s degree in the medical field is required for this position. The ideal candidate must be data-minded and driven. The candidate must also possess the ability and knowledge to create and organize a plan of action in order to improve the healthcare effectiveness data and information set success scores. If this sounds like it’s you, please don’t hesitate to apply for this position.

Typical duties and responsibilities

  • Update clinical quality metrics
  • Coordinate HEDIS processes and establish a plan to improve scores
  • Implement a process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities
  • Conduct quality audits
  • Maintain all data and process controls to ensure compliance

Education and experience

This position requires a bachelor’s degree in a science- or medical-related field. HEDIS certification is preferred by employers, as is 3+ years of quality-improvement or health care experience.

Required skills and qualifications

  • Excellent verbal and written communication skills
  • Strong organizational skills with the ability to keep accurate notes and records
  • Proficient in Microsoft Office Suite
  • Possess leadership capabilities

Preferred qualifications

  • Bachelor’s or master’s degree in health
  • 3+ years experience working as a HEDIS coordinator
  • Experience with the HEDIS system

Typical work environment

HEDIS, or the healthcare effectiveness data and information set, is a tool that is widely used in the medical field by medical professionals and offices in order to provide accurate data and assessment on the performance and success of various medical and healthcare treatments. This tool is commonly required to be used by a HEDIS coordinator, who has the job of understanding, modifying, and accurately recording the data from this tool in order to ensure the correct results. This coordinator is in charge of accurately parsing the data, recording and updating the clinical quality metrics, and adjusting the HEDIS process in order to ensure accurate scores. A HEDIS coordinator is required to have an intricate understanding of the healthcare effectiveness data and information set as well as other general healthcare terminologies and information.

Typical hours

The typical work hours for a HEDIS coordinator can be from 9 AM to 5 PM, Monday through Friday, in an office setting.

Available certifications

The HEDIS coordinator is one that requires much training and certification upkeep. Because of this, a HEDIS coordinator can benefit immensely from having the proper certifications. Some of these include:

  • CareNational HEDIS Training & Certification. The CareNational HEDIS training and certification is offered as an online course and certification bundle, which ensures professionals meet the basic standards for operation and understanding of the healthcare effectiveness data and information set. This course can be immensely useful for any professional looking to enter the HEDIS field.
  • Certified Hedis Compliance Auditor. Becoming a Certified HEDIS Compliance Auditor can demonstrate competence within the HEDIS system, as well as the ability to further understand and troubleshoot the system. Having this certification can demonstrate an ability to understand and maintain the quality of the HEDIS system, and can be beneficial to any HEDIS coordinator looking to continue and further their career.

Career path

The first step in becoming a HEDIS coordinator is to earn a bachelor’s degree in a science- or medical-related field and obtain three or more years of quality-improvement or other health care experience. While not always necessary to start, employers often strongly prefer candidates that have achieved HEDIS certification.

US, Bureau of Labor Statistics’ job outlook

SOC Code: 29-9098

2020 Employment81,400
Projected Employment in 203089,900
Projected 2020-2030 Percentage Shift 11% increase
Projected 2020-2030 Numeric Shift8,600 increase

The health care industry is generally increasing in size year after year. More people are accessing health care services, which creates a growing need for HEDIS coordinators and people working in the health care management and billing field.