Job Summary:

The primary role of the HEDIS Specialist is to capture all supplemental data available in the Medical Record in order to achieve the highest star score possible. This role will verify, update and maintain health related data per operational standard procedures.

Essential Functions:

• Collects data in accordance with HEDIS technical specifications requirements for supplemental data collection.
• Reviews provider progress notes and identifies specific documentation related to HEDIS/STAR defined quality measures.
• Conducts timely follow up requests to ensure records are received.
• Call patients to schedule PCP appointments to close care gaps.
• Logs, tracks, and monitors system notifications from providers or clinical staff regarding referrals to ER.
• Conducts a clinical patient follow up call within 24-48 hours to ensure patient status.
• Obtains admission and medical reports from patient records from approved hospital entities.
• Enters data into the tracking systems in retrieving information for reports.
• Works cooperatively with other sections of the clinic and assists in training of new associates as appropriate.
• Logs and tracks all mammograms manifest and documents all results from manifest log book.
• Works in collaboration with the laboratory department to ensure pap smears are obtained, scanned and documented in the EMR system.
• Logs, monitors and follows up on all patients’ ER documents received from hospital entities that were not referred by the Clinic.
• Reviews accuracy of Cancer Consortium packages submitted by Medical Assistants
• Audits and reviews all documents to ensure Cancer Consortium package is complete for all referrals within thirty days prior to submission to Cancer Consortium.
• Works with Cancer Consortium auditor to ensure all documents are complete for monthly audits.
• Reviews appointment schedules one week in advance to identify patients on Medicare Plans to ensure wellness referrals are completed prior to the appointment.
• Identifies patients that need wellness visits and collaborates with the scheduling department to schedule patients for future appointments.
• Generates letters to patients requesting immediate communication with the clinic regarding abnormal findings. Follows up with the patient if patient has not called regarding the sent letter.
• Processes forms or checks for results for various insurance groups and checks for referrals for ophthalmology, colonoscopy, fecal occult cards, bone density or mammogram screenings.
• Processes forms for all insurance companies on their website/portal and enters progress notes and studies.
• Maintains patient’s confidentiality according to HIPAA policies.
• Reports incidents to Risk Management and initiates reports when appropriate.
• Communicates and demonstrates the mission, ethics and goals of the facility.
• Performs other related duties as assigned.

Knowledge, Skills and Abilities:

• Organized, detailed-oriented and accurate
• Able to think and work effectively under pressure
• Ability to accurately complete and meet deadlines for time sensitive tasks
• Knowledge of the HIPAA privacy rules
• Ability to effectively prioritize multiple tasks and deadlines
• Computer literate.
• Good understanding of a clinic’s medical function and services in areas such as prenatal/pediatric/adult care, in-house and external appointments, etc.
• Familiar with medical terminology.
• Possesses excellent customer service and professional relations skills.
• Ability to work in a team environment

Minimum Qualifications:

• High School Diploma or GED.
• Two years’ experience in a clinical setting or successful completion of an accredited Medical Office Specialist program.
• Demonstrated proficiency in Microsoft Office programs (Word, Excel, and PowerPoint).
• Previous records collection experience is preferred.
• Bilingual (English/Spanish), preferred.

Job Type: Full-time

Pay: From $17.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• In-person

Work Location: In person