Rozina Aziz In this post, we’ll go over what HEDIS nursing is, what a HEDIS nurse does, what skills are helpful for HEDIS nurses to have, how to get started as a HEDIS nurse, and what to expect in terms of compensation and job security.
What is a HEDIS nurse?
Non-clinical nursing is called HEDIS nursing (Healthcare Effectiveness Data and Information Set Nursing). It involves nurses analyzing patient records and other medical paperwork with healthcare data and software to ensure that services align with patients’ health plans.
HEDIS, the brainchild of the National Council for Quality Assurance (NCQA), has become the gold standard for measuring the success of healthcare plans. And now, other healthcare providers have jumped on the bandwagon to join the HEDIS revolution.
HEDIS measurements, as described by ncqa.org, concentrate on the following areas:
- Experience in care
- Efficiency of Treatment
- Availability and Accessibility of Care
- A description of the health insurance plan
- Utilization/ risk-adjusted utilization
- Information and communication technologies
What does a HEDIS nurse do?
Health Effectiveness Data and Information Set (HEDIS) nurses analyze healthcare plans based on how they stack up against HEDIS benchmarks, developed from data collected on patients’ experiences in healthcare facilities. Some typical duties performed by HEDIS nurses include the following.
- Going to hospitals and clinics to get patient records.
- Gathering information from medical records for use in HEDIS reporting.
- Contact doctor’s offices and insurance providers by phone to get answers to questions and access records.
- Evaluating the quality of care provided by individual hospitals by analyzing patient data.
- Reviewing findings with HEDIS officials to make judgments about a healthcare facility and methods to improve patient care.
- Checking the quality of medical processes and tools by conducting on-site audits of healthcare institutions.
- Transforming patient charts, medical records, and other documents into structured data for inclusion in HEDIS databases.
- Comparing current facility data to historical data to ascertain whether or not the facility has made the necessary improvements to raise the quality of care provided to patients.
- Producing reports as necessary to detail how well a facility meets patient care needs.
Where Does A HEDIS Nurse Work?
As a HEDIS nurse, you may work in various environments. Hospitals, nursing homes, and independent clinics are all common employment locations for HEDIS nurses. But you can also work for an insurance provider or a health maintenance organization.
Working remotely is an option for some companies if you are a HEDIS nurse. Quality control and enhancing patients’ health will be your main priorities wherever you operate. You have the power to significantly improve the lives of individuals you serve by ensuring that they receive the treatment they require.
What are the Skills of HEDIS nurses?
Some examples of valuable abilities for HEDIS nurses include:
Knowledge of computers:
A HEDIS nurse’s day consists of sitting in front of a computer and poring over medical records and spreadsheets. As a result, understanding computers is a crucial technological competency.
Pay close attention:
Attention to detail is a key skill for HEDIS nurses. It helps them notice subtle changes in a patient’s condition or the quality of treatment they received, which can be used to assess if a health plan adjustment is necessary.
Curiosity:
To determine the cause of a patient’s health decline, HEDIS nurses must be curious about a wide range of medical issues, treatment plans, and care trends.
Communication:
Nurses participating in the HEDIS program need strong interpersonal skills to properly interact with patients’ medical insurance companies, doctors, and other administrative staff.
Knowledge To insurance:
To provide an accurate assessment of patient treatment, be thoroughly aware of various healthcare insurance providers, healthcare plans, and billing data.
Knowledge of medical terminology:
Nurses participating in the HEDIS benefit from a thorough understanding of language to decipher patient records, such as those detailing diagnoses and surgical procedures.
Expertise in medical coding:
Skills in medical coding are useful for HEDIS nurses because they allow them to quickly and efficiently locate information using medical codes and organize patient records and other documentation.
What are the pros and cons of being a HEDIS Nurse?
Pros:
- You can earn a respectable wage.
- You won’t need a master’s to get hired.
- You can supplement your income.
- There is a consistent availability of employment opportunities.
- It is possible that working from home is an option.
- It’s possible that you can set your hours.
- The work can be performed in various settings.
- You have the option of working either part-time or full-time.
- You may qualify for benefits twice.
- You’ll get to know new people who might offer fresh opportunities.
Cons:
- You will need to complete extra training.
- The nature of your work may vary with the seasons.
- How will you make money for the rest of the year?
- Feeling like an outsider at work is common.
- Meeting deadlines may require working extended hours.
- Be prepared for office politics.
- Maintaining a healthy work-life balance may be challenging.
- Travel may be required for professional purposes.
- Individuals who work remotely should provide their equipment.
- You won’t likely be eligible for benefits.
How to become a HEDIS nurse?
Consider the following guidelines for becoming a HEDIS nurse:
Get a nursing degree:
A HEDIS nurse must complete a two-year associate degree in nursing or a four-year bachelor’s degree in nursing. Both will prepare you to sit for the NCLEX-RN and work as a registered nurse in various settings, including medical clinics, nursing homes, and hospitals.
Professional experience in the healthcare industry:
Candidates must also have at least a few years of experience as registered nurses to be considered for a HEDIS nursing position. You can now learn more about patient care, healthcare policies, insurance plans, and medical records.
Certified in a field like medical coding:
Although it’s not required, a medical billing and coding certification can be useful in preparing for a HEDIS nurse position. Get ready to dive into medical coding, where you’ll be responsible for processing and organizing vital medical records.
Get the NCQA and apply:
You will need to register for an account before you can proceed. Afterward, you will find out how to apply and what is needed. After receiving an application, you must locate a sponsor (current or previous employer) to serve as a reference. A CV and cover letter may also be required to highlight your qualifications.
Research materials after application acceptance:
If the NCQA accepts your application, you can access study materials and guides.
Take the HEDIS Compliance Audit Test:
Prepare for a rigorous and exhilarating two-day NCQA exam process, complete with a thorough material review on day one and a four-hour exam on day two! Mark your calendar for this bi-annual event, and get ready to show off your knowledge.
Annual certification renewal:
After obtaining your initial HEDIS certification, you must renew it annually to maintain your status as a HEDIS-certified nurse.
Are HEDIS Nurses in High Demand?
Consider a healthcare career if you’re worried about your future employment prospects. A HEDIS nurse’s profession is no different. A HEDIS nurse can anticipate a bright future as the field is expected to expand. Demand for nurses in general, specifically HEDIS nurses, is high and expected to rise further.
Employers in the healthcare industry, including insurance firms, are on the hunt for talented individuals with HEDIS experience. Why? Because HEDIS is a game changer for monitoring and improving patient care. Don’t miss out on this opportunity to take your nursing career to the next level! A nurse with knowledge of HEDIS can assist a healthcare organization in meeting the requirements of this vital program.
An ever-evolving healthcare system is one of the factors contributing to a HEDIS nurse’s bright employment prospects. Constantly evolving norms, tools, and treatment protocols are being rolled out. As a result, hospitals require nurses who can easily adjust to changing conditions and circumstances. A HEDIS nurse can keep up with the ever-evolving healthcare industry, allowing them to efficiently integrate new procedures without negatively impacting the patient experience.
The growing significance of HEDIS nurses’ work in the healthcare sector is another factor contributing to this profession’s bright employment prospects. More and more healthcare providers rely on HEDIS nurses to assist them in achieving their quality care goals. As a result, the need for nurses proficient in HEDIS is increasing. Individuals with qualifications for this position can look forward to a prosperous nursing career.
The high level of job satisfaction experienced by HEDIS nurses is the third factor contributing to the bright future of the nursing profession. Nurses who participate in HEDIS find satisfaction in positively impacting their patients’ lives and elevating healthcare standards for everyone. They enjoy contributing to a team effort and feeling satisfied when they observe positive changes in patient outcomes.
What is the Salary and Job Outlook of HEDIS Nurses?
In the United States, a HEDIS nurse may anticipate an average annual pay of $82,751. HEDIS nurses may generally expect pay between $40,000 and $60,000 per year. However, this range might be wider or narrower based on geography, company, and years of experience in the field.
The Bureau of Labor Statistics predicts a 7% increase in job opportunities for registered nurses from 2019 to 2029. And get this – that’s faster than the average growth rate for similar occupations! Plus, the HEDIS sector may see a similar boom in nursing jobs. It’s an exciting time to be in the healthcare field!
FAQ’s
Who submits data to HEDIS?
The HEDIS measurements in Table 3 must be reported by all SNP and MMP PBPs. If a contract has multiple Qualifying PBPs, each Qualifying PBP must submit its report detailing the metrics in Table 3. There are no additional PLD files that MMPs or contracts with SNP PBPs must report.
Is HEDIS an audit?
The Healthcare Effectiveness Data and Information Set is an audit used by government agencies, healthcare providers, and others to assess and enhance the quality of health insurance policies throughout the country.
