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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in HEDIS improvement initiatives, provider engagement, and healthcare outcomes enhancement. Proficient in medical record abstraction, compliance with regulatory requirements, and effective communication with healthcare providers.
Highest-signal resume keywords
HEDIS ImprovementMedicare ExperienceMedical Record AbstractionProvider EducationCPT/CPTII/ICD9/ICD10 Coding
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
HEDISMedical Record AbstractionCPT CodingICD9 CodingICD10 CodingHealthcare ComplianceProcess ImprovementData AnalysisProductivity MetricsQuality Management
Soft Skills
Strong Communication SkillsIndependent WorkCollaborationPublic SpeakingRelationship Management
Tools & Technologies
Standard Corporate Software PackagesDigital Solutions
Industry Keywords
HealthcareMedicareManaged CareQuality InitiativesPreventive Care Compliance
About the role
Key responsibilities & impact- Serve as a subject matter expert in HEDIS improvement work
- Interact with providers and/or members to improve healthcare outcomes, including preventive care compliance
- Support provider engagement and participate actively in workgroups
- Deliver quality information to internal and external constituents through written and verbal communication
- Identify process improvement opportunities and create efficient work streams
- Independently map provider outreach work plans and execute deliverables
- Support complex relationships with internal and external constituents
- Consult on solutions to business issues, education, and process improvement opportunities
- Support provider partners with HEDIS gaps in care, digital solutions, remote medical record collection discussions, and education
- Collaborate with provider partners to enhance collaboration with Aetna
- Support HEDIS quality initiatives and regulatory/contractual requirements, including outreach to noncompliant members
- Support medical record capture for HEDIS medical record review and abstraction of supplemental data
- Participate in public speaking
Requirements
What you’ll need- 3+ years of recent and related health care experience in any setting
- 1+ years of Medicare experience and/or 1+ years of HEDIS medical record abstraction experience
- 1+ years of member/provider education experience targeting gaps in care
- Experience successfully performing in an environment where daily/weekly productivity metrics are expected
- Ability to work independently
- Ability to use standard corporate software packages and applications
- Strong communication skills
- Experience speaking with medical providers and/or medical office staff
- Recent and related experience working with HEDIS
- Medicare Stars experience or health insurance experience
- Health care related experience in clinical, managed care or quality management
- Understanding of CPT/CPTII/ICD9/ICD10 coding and medical terminology
- Bachelor’s Degree OR equivalent experience in healthcare
Benefits
Comp & perks- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission or short-term incentive program eligibility