Care Coordination Specialist — US Healthcare (Quality & HEDIS)

Location: India (from Chennai) · Shift: US hours (night shift IST)

About the role

You will coordinate directly with US provider offices and retail pharmacies to close open quality care gaps. This is an outcome-owned role: every day you are chasing evidence—a lab result, an eye exam report, a fill date—and getting it into the system so a gap can be marked closed.

What you'll do

• Coordinate with US healthcare offices to obtain missing clinical evidence: A1c and BP values, diabetic retinal eye exam results, mammogram and colonoscopy reports, and other HEDIS/Stars measure documentation
• Coordinate with retail and mail-order pharmacies to verify last fill date, days supply, and refill status for adherence measures (diabetes, hypertension, statins) and drive refill conversions
• Review returned charts and records, abstract the qualifying evidence, and determine whether a gap is compliant, non-compliant, or requires exclusion
• Update outcomes accurately into the client's population health platform or EMR and maintain a clean daily disposition log
• Coordinate appointment scheduling with practice staff where a gap requires an in-office visit
• Track and report daily outreach volume, contact rate, evidence obtained, and gaps closed

Required

• 2+ years in a US healthcare outreach or coordination process — HEDIS abstraction or record retrieval, prior authorization, AR follow-up, or provider engagement
• Clear spoken English and strong verbal communication
• Working knowledge of US healthcare terminology: payers, IPA's, NPI, EMR/EHR, faxback, ROI, POS
• Able to read a clinical chart and identify a date, value, and provider
• Willing to work US business hours from India, full time

Preferred

• Direct HEDIS/Stars gap closure experience or NCQA HEDIS season work
• B.Pharm, Pharm.D, BDS, BHMS, BAMS or BSc Nursing background
• Experience with population health or quality platforms (Innovaccer, Arcadia, Reveleer, Inovalon, Athena, eCW)
• Experience with EMR systems like Athena / all scripts/ veradigm etc