If you are located within 30-40 miles of Abilene, TX, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.

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.

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.

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.

We offer 12 weeks of paid training. The hours during training will be 8am to 5pm, Monday - Friday. Training will be conducted virtually from your home.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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 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.

Required Qualifications:

• High School Diploma / GED
• Must be 18 years of age or older
• 3 years of healthcare experience to include experience in a managed care setting
• 3 years 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.
• Must have reliable transportation. You will be visiting doctor’s offices 2 days per week, 3 days per week working from home.
• Ability to work our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.

Preferred Qualifications:

• Licensed Vocational/Registered Nurse, or Certified Professional Coder
• 2 years of experience working with HEDIS/STAR measures
• 1 years of HEDIS/STAR experience or participation with similar regulatory reporting
  
• ICD 9/10 and CPT coding experience
• EMR and HEDIS knowledge and experience
• Experience working in a physician, provider, and/or medical office 

Telecommuting Requirements:

• Reside within 30-40 miles of Abilene, TX
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for 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.

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