8 Hedis Jobs

As a Data Analyst with deep experience in the US Healthcare industry and skills around Machine Learning (ML), you will play a vital role in conducting comprehensive data analysis using statistical and exploratory methods to uncover patterns and insights that drive data-driven decision-making in the healthcare domain. Leveraging your knowledge of healthcare industry metrics such as HEDIS, CMS Star Ratings, risk adjustment models, and revenue cycle data, you will optimize analytics strategies to ensure efficient data quality, availability, and reliability for AI/ML-driven healthcare analytics solutions. Your responsibilities will include designing and maintaining data pipelines for the ingestion, transformation, and storage of claims, electronic health records (EHR), HL7/FHIR data, and real-world evidence (RWE) while ensuring compliance with HIPAA, PHI, and other regulatory requirements. Collaborating closely with data science and engineering teams, you will develop and maintain dashboards and reports that translate complex healthcare data into actionable insights for business stakeholders using visualization tools such as Streamlit, Snowflake, Power BI, or similar platforms. You will apply your expertise in healthcare cost, quality, and operational performance analytics to deliver meaningful insights and work closely with cross-functional teams, including data science, engineering, API development, and healthcare operations, to understand data needs and deliver tailored solutions. Additionally, you will engage with industry experts, attend relevant healthcare and data science conferences, and contribute to continuous learning within the team to enhance process understanding and ensure data accuracy for regulatory and business reporting. To excel in this role, you should have strong proficiency in SQL and Python, including libraries such as pandas for data manipulation and analysis. Experience with healthcare data visualization and storytelling tools, familiarity with ETL pipelines, data warehousing, and cloud platforms (AWS, Azure, GCP) for healthcare data processing, as well as knowledge of healthcare standards and regulations are essential. Experience in revenue cycle management (RCM), medical coding (ICD, CPT, DRG), and healthcare cost/utilization analytics is a plus, along with the ability to analyze complex healthcare datasets and derive meaningful insights impacting operational efficiency, patient outcomes, and cost optimization. Excellent communication and stakeholder management skills, with the ability to translate technical findings into business insights, are key to collaborating effectively with healthcare business teams, IT, and data science professionals. A curious mindset and willingness to explore new challenges and drive innovation in healthcare analytics are also important qualities for success in this role.,

Job Title: Risk Adjustment Coder Location: Kolkata Job Type: Full-time Job Overview: Seeking skilled individuals for our medical coding team to conduct retrospective and concurrent chart reviews. Use HCC coding expertise to translate, input, extract, and validate medical data. Collaborate with Certified Risk Coders and Supervisors to ensure accurate diagnosis documentation and HCC abstraction through daily chart reviews. Responsibilities: Collaborate with Certified Risk Coders and Supervisors on daily chart reviews. Demonstrate strong ICD-10 coding knowledge. Follow client-specific guidelines and updates for chart coding. Exhibit strong qualitative and analytical skills. Possess knowledge of medical terminology. Demonstrate computer skills, including typing ability. Meet deadlines with minimal direction and low error rate. Communicate effectively with all organizational levels. Review comprehensive patient medical records to ensure diagnosis codes are supported and compliant (M.E.A.T). Evaluate diagnoses for Hierarchical Condition Categories (HCC) coding. Maintain compliance, confidentiality, and uphold the organization's mission and philosophy. Qualifications: Knowledge: Strong working knowledge of ICD-10 and Risk Adjustment models. Experience: CPC, CCS or CCS-P Certification required. Minimum 2 years of HCC (Hierarchical Condition Category) coding experience for professional services across multiple specialties required. Certified Risk Adjustment Coder (CRC) through AAPC desired. Skills: Familiarity with Medicare Advantage plan operations including HEDIS, AWVs, HCCs, and RAF scoring. Good communication and interpersonal abilities. Basic computer proficiency in MS Excel, Word, PowerPoint, and standard typing speed. Benefits: Competitive salary Health insurance coverage Professional development opportunities Collaborative and supportive work environment

Roles and Responsibilities : Any graduate with minimum 1.2 years of experience in HCC Coding HEDIS experience candidates are preferrable Should have active coding credentials through AAPC/AHIMA is Mandatory Experience in HCC record abstraction and coding required Demonstrate high level of quality in clinical coding work, identifying and validating HCC mapped diagnoses that are revenue generating Adherence to official coding guidelines, coding clinic determinations, client specific coding guidelines, CMS and other regulatory compliance guidelines and mandates. Experience in medical record validation of correct coding procedures and guidelines Identified by accuracy of 95% or above and consistent productivity Excellent written and verbal skills to include coaching and interpersonal skills Strong knowledge of medical terminology, anatomy and physiology Skills in organization, time management and customer service Ability to read and understand medical record documentation for diagnosis extraction Analytical and problem-solving skills Must abide by all HIPAA and associated patient confidentiality requirements Must be able to identify trends in coding and documentation errors

POSITION SUMMARY The Senior MD Analyst is responsible for supporting the development and design of clinical information systems and treatment protocols for the deployment of ZeOmega's Jiva platform. The role is responsible of abstraction, analysis and submission of clinical data. This position will work on the quality and coordination of data collection, entry, analysis, submission, report preparation, presentation of data, data sharing for process improvement initiatives, bench marking and outcomes research. This position communicates the report findings to others throughout the organization, including recommendations for improvements and focused studies. Works in partnership with ZeOmega leadership personnel in research, system configuration and testing, implementation, and translation of clinical requirements into specifications for clinical protocols. PRINCIPLE JOB RESPONSIBILITIES: Provides precise input into the development of clinical rules supporting identification, care management plans, potential gaps in care, and protocol research, as well as the design of the clinical system, features supporting protocol management, and the use of the system to leverage the clinicians' time and maximize communication among stakeholders • Identify new ways to ensure that the data and metrics supporting our operational decisions is accurate and timely Provides analysis of regulatory and guidelines changes in the industry, e.g., HEDIS, Stars, NCQA, URAC, and applicability to product configurations and new development • Lead in providing the broad-based and in-depth input regarding the design of the clinical information system protocols Collaboration leadership within the team and cross-functional teams to design clinical systems to support excellence in patient care plans Reviews medical informatics trends, experiences, and approaches to develop clinical/technical and application implementation strategies and protocols. • Works in a cross-functional team with Business Analysts (BA) and Subject Matter Experts (SME) to design and implement systems supporting care management and physician engagement regimens. Collaborate with analytics and operational leaders to develop insights that will drive better understanding of patient utilization and cost drivers • Facilitates the design of clinical pathway models with a physician, nursing, and administrative leadership, and will assist in modification and annual review of these models to gain maximum efficacy Participates in the development and deployment of solutions that cluster information in disease and episodic categories for benchmarking, clinical severity, and variance analysis Lead the design and evaluation of collection of data for clinical purposes, including tracking and interpretation of outcomes • Participates in determining content and design of care management and provider reports • Conduct worldwide medical/clinical literature, regulatory, and program research to develop innovative health promotion and medical/behavioural health management programs Experience: 10+ years of experience in relevant technology and industry. Education: MBBS Skills: HEDIS and/or Stars knowledge preferred. • US Healthcare experience preferred. • Expertise in US Managed Health and/or ACO delegated care management preferred. • Clinical analysis from regulations (Medicare and Medicaid) and nationally recognized guidelines (NCQA, URAC) and standards preferred. • Familiarity with evidence-based clinical protocol development required. • Knowledge of machine learning and artificial intelligence in clinical analytics preferred. • Knowledge of patient engagement and digital engagement strategies. Proven collaboration and communication skills within a cross-functional team environment.

Cotiviti Hiring HCC Medical Coders For Coimbatore & Hyderabad for HEDIS Department: HCC Coding Role: Medical Coder / Sr Medical Coder Job Location: Coimbatore & Hyderabad Eligibility Criteria: Any graduate with minimum 1.2 years of experience in HCC Coding HEDIS experience candidates are preferrable Should have active coding credentials through AAPC/AHIMA is Mandatory Experience in HCC record abstraction and coding required Demonstrate high level of quality in clinical coding work, identifying and validating HCC mapped diagnoses that are revenue generating Adherence to official coding guidelines, coding clinic determinations, client specific coding guidelines, CMS and other regulatory compliance guidelines and mandates. Experience in medical record validation of correct coding procedures and guidelines Identified by accuracy of 95% or above and consistent productivity Excellent written and verbal skills to include coaching and interpersonal skills Strong knowledge of medical terminology, anatomy and physiology Skills in organization, time management and customer service Ability to read and understand medical record documentation for diagnosis extraction Analytical and problem-solving skills Must abide by all HIPAA and associated patient confidentiality requirements Must be able to identify trends in coding and documentation errors Interested Candidates can share their resume to the email id abdul.rahuman@cotiviti.com (or) contact the number for booking online interviews. Abdul Rahuman - 9080276094 Regards Abdul Rahuman - Talent Acquisition

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Primary Responsibilities: Lead a team of 25-30 certified coders. Maintains staff by recruiting, selecting, orienting, and training employees; maintaining a safe, secure, and legal work environment; developing personal growth opportunities Performance Management Timeliness, Quality and Productivity metrics Planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards Maintains quality service by enforcing quality and customer service standards; analyzing and resolving quality and customer service problems; identifying trends; recommending system improvements Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so Required Qualifications: Graduate in any discipline Experience of handling HCC team (QRAO) for 2+ years as assistant manager or working as deputy manager Experience in Performance Management, Project Management, Coaching, Supervision, Quality Management, Results Driven, Developing Budgets, Developing Standards, Foster Teamwork, Handles Pressure, Giving Feedback Proven ability to use Microsoft Office Products (Excel, PowerPoint etc) Proven ability to operate basic office equipment (copier and facsimile machine) At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes an enterprise priority reflected in our mission. #njp

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Primary Responsibilities Lead a team of 25-30 certified coders. Maintains staff by recruiting, selecting, orienting, and training employees; maintaining a safe, secure, and legal work environment; developing personal growth opportunities Performance Management - Timeliness, Quality and Productivity metrics Planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards Maintains quality service by enforcing quality and customer service standards; analyzing and resolving quality and customer service problems; identifying trends; recommending system improvements Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so Required Qualifications: Graduate in any discipline Experience of handling HCC team (QRAO) for 2+ years as assistant manager or working as deputy manager Experience in Performance Management, Project Management, Coaching, Supervision, Quality Management, Results Driven, Developing Budgets, Developing Standards, Foster Teamwork, Handles Pressure, Giving Feedback Proven ability to use Microsoft Office Products (Excel, PowerPoint etc) Proven ability to operate basic office equipment (copier and facsimile machine)

Role: Product Owner Product Owner Key Responsibilities: Define and communicate the product vision and strategy. Lead the product development lifecycle from ideation to launch, ensuring alignment with business goals and user needs. Collaborate with engineering teams to prioritize features and manage the product backlog effectively. Conduct research and competitive analysis to identify trends, opportunities, and potential areas for product enhancement. Engage with healthcare payers leaders, and regulatory bodies to gather insights and feedback on product performance and usability. Monitor and analyze product performance metrics to inform decision-making and drive continuous improvement. Foster a culture of innovation and collaboration within the product team and across the organization. Act as the primary point of contact for stakeholders, providing updates on product progress and soliciting feedback. Mentor and guide junior product managers and team members to develop their skills and capabilities. Required Qualifications: Education: Bachelor’s degree in Business Administration, Healthcare Management, Computer Science, or a related field. Master’s degree (MBA or similar) preferred but not required. Experience: Minimum of 9+ years of product management experience, with at least 3 years in a leadership role. Proven track record of successfully managing complex technology products, preferably in the healthcare or health technology sector. Strong understanding of HEDIS measures, healthcare quality metrics, and regulatory requirements. Experience working with cross-functional teams, including engineering, design, and data analytics. Familiarity with Agile methodologies and tools (e.g., Scrum, JIRA, Confluence). Excellent communication, presentation, and interpersonal skills, with the ability to engage and influence stakeholders at all levels. Analytical mindset with a strong ability to interpret data and drive data-informed decisions. Preferred Qualifications: Experience with healthcare data analytics, data integration, and reporting tools. Knowledge of electronic health records (EHR) systems and healthcare interoperability standards. Certification in product management (e.g., Certified Scrum Product Owner, Certified Product Manager) is a plus