UnitedHealth Group Quality Coordinator USMD Clearfork in Fort Worth, Texas
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.
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
Maintains education / knowledge base of HEDIS / STARs
Performs all other related duties as assigned
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
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.
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
This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor’s diagnosis of disease
Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
Licensed Vocational / Registered Nurse, or Certified Professional Coder
1+ years of HEDIS / STAR experience or participation with similar regulatory reporting
2+ years of college, in pursuance of a Bachelor’s or Associate’s degree
2+ years of experience working with HEDIS / STAR measures
ICD 9/10 and CPT coding experience
Experience working in a physician, provider, and/or medical office
EMR and HEDIS knowledge and experience
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors., WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for 550,000+ older adults with over 16,000 doctors’ offices 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 yourlife's best work.(sm)
Diversity creates a healthier atmosphere: 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.
Job Keywords: Medical Assistant, WellMed, Lake Worth, Fort Worth, Clearfork, TX, Texas
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