Website UnitedHealth Group

Position Description

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing 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
  • 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

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
  • Proficient using Microsoft office applications (mainly word and excel)

Preferred Qualifications:

  • 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
  • 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. We’re impacting 240,000+ 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)
 


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.

Job Keywords: Quality, Care Team, Clinical Administrative, medical terminology, data mining, managed care, Medical office, San Antonio, TX, Texas