Quality Coordinator West TX
Company: UnitedHealth Group
Location: Wichita Falls
Posted on: June 15, 2022
Job Description:
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 life's 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
provider's offices as needed
- Maintains education/knowledge base of HEDIS/STARs
- Performs all other related duties as assignedYou'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.Required Qualifications:
- High School diploma or GED
- 3+ years of healthcare experience to include experience in a
managed care setting
- 3+ years of experience with data analysis/quality chart
reviews. Must be able to review data and provide recommendations
for improvement
- Experienced using Microsoft office applications, including
databases, word-processing, and excel spreadsheets
- Full COVID-19 vaccination is an essential job function of this
role. Candidates located in states that mandate COVID-19 booster
doses must also comply with those state requirements. UnitedHealth
Group will adhere to all federal, state and local regulations as
well as all client requirements and will obtain necessary proof of
vaccination, and boosters when applicable, prior to employment to
ensure compliance. Candidates must be able to perform all essential
job functions with or without reasonable accommodationPreferred
Qualifications:
- Licensed Vocational/Registered Nurse, or Certified Professional
Coder -
- 2+ years of college, in pursuance of a Bachelor's or
Associate's degree
- 2+ years of experience working with HEDIS/STAR measures
- 1+ years of HEDIS/STAR experience or participation with similar
regulatory reporting
- Experience working in a physician, provider, and/or medical
office -
- ICD 9/10 and CPT coding experience -
- EMR and HEDIS knowledge and experiencePhysical & Mental
Requirements: -
- Ability to lift up to 10 pounds
- Ability to push or pull heavy objects using up to 50 pounds of
force
- Ability to stand for extended periods of time
- Ability to use fine motor skills to operate equipment and/or
machinery
- Ability to properly drive and operate a company vehicle
- Ability to receive and comprehend instructions verbally and/or
in writing
- Ability to use logical reasoning for simple and complex problem
solving
- Occasionally requires exposure to communicable diseases or
bodily fluidsTo protect the health and safety of our workforce,
patients and communities we serve, UnitedHealth Group and its
affiliate companies require all employees to disclose COVID-19
vaccination status prior to beginning employment. In addition, some
roles and locations require full COVID-19 vaccination, including
boosters, as an essential job function. UnitedHealth Group adheres
to all federal, state and local COVID-19 vaccination regulations as
well as all client COVID-19 vaccination requirements and will
obtain the necessary information from candidates prior to
employment to ensure compliance. Candidates must be able to perform
all essential job functions with or without reasonable
accommodation. Failure to meet the vaccination requirement may
result in rescission of an employment offer or termination of
employment.Careers with WellMed. Our focus is simple. We're
innovators in preventative health care, striving to change the face
of health care for seniors. We're impacting 550,000+ lives,
primarily Medicare eligible seniors in Texas and Florida, through
primary and multi-specialty clinics, and contracted medical
management services. We've joined Optum, part of the UnitedHealth
Group family of companies, and our mission is to help the sick
become well and to help patients understand and control their
health in a lifelong effort at wellness. Our providers and staff
are selected for their dedication and focus on preventative,
proactive care. For you, that means one incredible team and a
singular opportunity to do your life's best work.(sm)WellMed was
founded in 1990 with a vision of being a physician-led company that
could change the face of healthcare delivery for seniors. Through
the WellMed Care Model, we specialize in helping our patients stay
healthy by providing the care they need from doctors who care about
them. We partner with multiple Medicare Advantage health plans in
Texas and Florida and look forward to continuing growth.Diversity
creates a healthier atmosphere: OptumCare is an Equal Employment
Opportunity/Affirmative Action employers 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.OptumCare is a drug-free
workplace. Candidates are required to pass a drug test before
beginning employment.
Keywords: UnitedHealth Group, Wichita Falls , Quality Coordinator West TX, Other , Wichita Falls, Texas
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