Hedis Coordinator

WELLBE INTRODUCTION

WellBe is a Physician Led, Advanced Practice clinician driven, geriatric care (care of older adults) team focused on the care of the frail, poly-chronic, elderly Medicare Advantage patients. This population is typically undeserved and very challenged with access to care. To address these problems, we have elected to bring the care to the patient, instead of trying to bring the patient to the care. Care is provided throughout the entire continuum of care - from chronic care and urgent care in the home, to hospital, to skilled nursing facility, to assisted living, to palliative care, to end of life care. WellBe's care teams’ partner with the patient’s primary care physician to provide concierge level geriatric medical care and social support in the home as well as delivering and coordinating across the entire care continuum.

General Summary

The Quality / HEDIS Coordinator plays a critical role in supporting the organization in achieving high quality outcomes nationally. This representative serves as a liaison between central quality and local market team in supporting and facilitating medical record reviews and reporting, assisting with process improvement initiatives designed to improve HEDIS measure performance, and performing functions related to outreach, collection, review and data entry of medical records and service data, according to HEDIS technical specifications. The Quality / HEDIS Coordinator will interface with clinicians, patients, and internal staff to obtain and review data. Attendance with regular team meetings to report findings of data collection/project and quickly escalating identified problems to be corrected is a key part of this role.

We are looking for individuals with healthcare and medical record review background, telecommunications and quality/HEDIS experience to engage patients with complex healthcare needs who require assistance with coordination of care. The ideal candidate will have excellent written and oral communication skills, pay attention to detail, and be comfortable in working within a dynamic environment.

To be successful in this job you must also be very comfortable with meeting daily record review volume goals, strive to meet/exceed departmental and organizational goals, work on several different computer programs and interpret data quickly and accurately.

You will process a substantial amount of patient information every day and be expected to work both independently and as part of a team within a multi-disciplinary environment. You will have the satisfaction of knowing that YOU are helping our patients receive high quality patient care and improving their clinical outcomes.

POSITION RESONSIBILTIES

• Retrieves medical records and performs chart / medical records reviews utilizing HEDIS technical specification criteria or internal guidelines.
• Thoroughly, accurately, and timely collects and data enter clinical information from medical records into EMR / internal database in accordance with HEDIS technical specifications.
• Retrieves, faxes, and scans files to and from various electronic medical record and other systems.
• Outreach to patients and clinical providers to effectively coordinate care, obtain records and ensure patients receive preventive and chronic disease management services. The goal of these messages is to remind providers, identify if any screenings have already been performed and, if they have not been completed, to assist in any way possible to complete the screenings
• Assist in developing programs, mailers, campaigns for promoting the necessary services and required screenings.
• Confirms patients' demographic information as necessary to effectively coordinate care.
• Directs patient or clinician inquiries to appropriate clinical staff and reports escalations/complaints immediately to appropriate management staff.
• Prepares and maintains records and files that are organized, thorough and readily accessible.
• Adheres to HIPAA requirements while contacting patients, providers, and handling protected health information accessed during normal work activities.
• Applies excellent communication, customer service, and problem-solving skills to all interactions. Transmits ideas and information in a clear and concise manner.
• Behaves in a professional manner when interfacing with Medical Directors, Physicians (including office staff) and all internal and external customers. Keeps a high level of customer service and professionalism when speaking to patients, providers, and other employees.
• Ability to adhere to a fixed daily schedule, including start, break, lunch, and end times.
• Ability to manage a heavy workload with frequent interruptions and changing priorities in a fast-paced environment.
• Able to work well in a team environment on special projects.
• Strong computer skills and ability to use multiple systems at the same time, while making outreach calls
• Completes assignments within specified deadlines.
• Other duties as assigned.
  
  
  

Educational Requirements

• High school diploma or equivalent
• Minimum of 3 years of experience in healthcare setting or outreach demonstrating ability to influence customers/ members; or any combination of education and experience, which would provide an equivalent background.
• Medical assistant experience preferred.
• NCQA HEDIS, Quality or Medicare Star Rating program experience preferred.
  
  
  

Required Skills and Abilities

• Healthcare experience is required.
• NCQA HEDIS, Quality and/or Medicare Star Rating program experience preferred.
• Excellent reading comprehension skills to analyze and process the information collected and distributed.
• Call center experience preferred.
• Strong orientation towards excellence, willing to go the extra mile.
• Strong accountability and discipline against timelines and deliverables
• Easily navigates through multiple computer systems.
• Strong proficiency in MS Office (e.g., Excel) and Google documents/spreadsheets
• Comfortable on the phone to engage with patients, caregivers, pharmacies, doctor offices, insurance, etc.
• Ability to synthesize and analyze large amounts of data to make sound business decisions.
• Requires strong oral, written, and interpersonal communication skills, problem-solving and facilitation skills.
• Excellent detail orientation and organizational skills
• Quick learner and comfortable with high level of ambiguity
  
  
  

Supervisory Responsibility This position will have no direct reports at this time.

Travel requirements This position requires no travel.

Work Conditions Ability to lift up to 20lbs.

The preceding functions may not be comprehensive in scope regarding work performed by an employee assigned to this position classification. Management reserves the right to add, modify, change, or rescind the work assignments of this position. Management also reserves the right to make reasonable accommodations so that a qualified employee(s) can perform the essential functions of this role.