Quality & HEDIS Outreach Specialist

Position Summary

BKG Enterprises is seeking a Quality & HEDIS Outreach Specialist to support Medicaid quality improvement and member health outcome initiatives. This position will focus on reviewing and validating member data, identifying gaps in care, supporting HEDIS and other quality campaigns, conducting targeted member outreach, and tracking outcomes.

The ideal candidate is detail-oriented, comfortable working with healthcare data and reports, and able to turn information into actionable outreach that supports improved member health outcomes.

Hours: Monday - Friday 8-5

Pay: $20-24/hr

Benefits: Health, Dental, Vision

80 hours of PTO

10 paid holidays

Key Responsibilities

• Review and validate member lists, gaps-in-care reports, and other healthcare data used for outreach campaigns. 
• Identify members with open preventive, chronic care, or other quality-related needs. 
• Support HEDIS, Core Set, immunization, pharmacy adherence, health needs screening, and other quality improvement initiatives. 
• Identify trends, inconsistencies, and opportunities within member and outreach data. 
• Prepare and organize targeted outreach lists based on program and health plan priorities. 
• Identify members who have been difficult to engage and support targeted strategies to reach them. 
• Conduct member outreach when needed to assist with closing identified gaps in care. 
• Assist members with scheduling preventive, wellness, follow-up, and other needed healthcare appointments. 
• Support gap closure activities including immunizations, A1c testing, lead testing, blood pressure screenings, telehealth appointments, and other identified health needs.  
• Track outreach attempts, successful contacts, interventions, appointments, and outcomes. 
• Maintain accurate and timely documentation within designated systems. 
• Assist with weekly, monthly, and quarterly reporting of outreach activity, campaign performance, and health outcomes. 
• Collaborate with BKG leadership and health plan partners to adjust priorities based on changing quality initiatives. 
• Maintain compliance with HIPAA, Medicaid requirements, approved processes, and company policies. 

Key Measures of Success

• Accuracy of member and gaps-in-care data. 
• Completion of assigned campaigns. 
• Successful member engagement. 
• Care gaps closed through outreach. 
• Appointment scheduling and completion. 
• Accurate and timely documentation. 
• Contribution toward HEDIS and other quality improvement goals. 
• Timely and accurate reporting.

Qualifications

• Previous experience in healthcare quality, HEDIS, population health, managed care, Medicaid, healthcare operations, or healthcare data preferred. 
• Experience working with gaps-in-care reports, member data, healthcare reports, or quality measures preferred. 
• Strong Excel and data management skills. 
• Strong attention to detail and ability to identify trends and inconsistencies. 
• Ability to interpret data and translate findings into actionable next steps. 
• Strong organizational and analytical skills. 
• Strong written and verbal communication skills. 
• Ability to manage multiple priorities and outreach campaigns. 
• Experience with electronic health plan, care management, CRM, or similar systems preferred. 
• Knowledge of HIPAA and handling confidential healthcare information.