Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your lifes best work.(sm)
This position is responsible for 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 .
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 scheduling 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 billing practices
- Activities may include data collection, data entry, quality monitoring, health plan / WellMed form submission and chart collection activities
- Assists with local IRR audits
- Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS / Star measures
- Support chart chase process by requesting records from providers offices as needed
- Maintains education/knowledge base of HEDIS / STARs
- Performs all other related duties as assigned
Youll 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.
