Opportunities at WellMed , part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together. This position is responsible for effectively supporting the successful implementation and execution of all Clinical Quality processes. The Quality Coordinator will provide support to the coordination of HEDIS and STARs data gathering process. This evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, identifying trends, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records. This position will serve as a liaison with internal/external customers/departments to ensure optimal customer service.This position will offer a Hybrid role with 3 days in office, and 2 days remote.Primary Responsibilities:
Assisting in the review of medical records to highlight Star/HEDIS opportunities for the medical staff
Review medical records for data collection, data entry, and quality monitoring including health plan/WellMed form submission and chart collection activities that close gaps in care
Partner with the leadership team, the practice administrative or clinical staff to identify trends observed and potential strategies to support the practice
Communicate challenges or trends that may negatively impact quality outcomes
Track and trend barriers/challenges that exist at their assigned groups so that better outcomes can be achieved including access to appointments lack of follow up on referrals, or inconsistent coding practices
Activities may include data collection, data entry, quality monitoring, health plan/WellMed form submission and chart collection activities
Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures
Support quality initiatives by requesting medical records from provider’s offices as needed
Receives and responds to incoming Clinical Quality inquiries from all communication venues: e.g. phone and fax queue, TruCare, or department e-mail box
Conducts in-bound and out-bound calls for quality requirements including, but not limited to: patient scheduling, medical records requests, contact verification
Documents timely patient and clinic interactions of in-bound and/or out-bound calls into software applications
Provides clerical and/or administrative support to quality staff and managers for special projects and reporting needs
Provides excellent customer service by serving as a resource to all internal and external customers
Maintains education/knowledge base of HEDIS/STARs
Performs all other related duties as assigned
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.One year of post-high school education can be substituted/is equivalent to years of experience.Required Qualifications:
1+ years of HEDIS/STAR experience or participation with similar quality regulatory reporting
EMR and HEDIS knowledge and experience
Medical terminology knowledge base
Experience using Microsoft Office applications, including Excel, Word, and Outlook
Preferred Qualifications:
Certified Medical Assistant training or certification
3+ years of experience with data analysis/quality chart reviews
2+ years of experience in a physician’s clinic or hospital
Experience working in a medical care setting as a receptionist or medical assistant
Bilingual language proficiency (English/Spanish)
Proven ability to work independently, with some supervision and direction from manager
Demonstrated excellent organizational skills, customer service skills, to include verbal and written communication. Must maintain and demonstrate a high degree of professionalism to include both personal conduct and appearance at all times
Proven ability to maintain strict confidentiality at all times
Proven ability to adhere to all department/ organizational policies and procedures
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves 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.Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.