Field-Based Senior Practice Performance Specialist in Pittsburgh, PA

About the role

The Field-Based Senior Practice Performance Consultant in Pittsburgh, PA and Surrounding Areas works on-site or virtually to support medical centers and physician practices managing a high volume of UHC Medicare & Retirement membership. This position focuses on reviewing medical records, identifying HEDIS gaps in care, and optimizing quality measures for Medicare Advantage Members.

Responsibilities

• Partner with leadership and practice staff to determine strategies for supporting the practice and its members, ensuring recommended preventative health screenings are completed and HEDIS gaps are addressed.
• Meet virtually with providers to discuss Optum tools and programs aimed at improving the quality of care for Medicare Advantage Members.
• Execute applicable provider incentive programs for the health plan.
• Assist in the review of medical records to highlight Star opportunities for the medical staff.
• Activities include data collection, data entry, quality monitoring, upload of images, and chart collection activities.
• Locate medical screening results/documentation to ensure quality measures are followed in the closure of gaps. Will not conduct any evaluation or interpretation of clinical data.
• Track appointments and document information completely and accurately in all currently supported systems in a timely manner.
• Optimize customer satisfaction, positively impact the closing of gaps in care and productivity.
• Interact with UHC members via telephone to assist and support an appropriate level of care. This may include making outbound calls to members and/or providers to assist in scheduling appointments, closing gaps in care or chart collection activities.
• Answer inbound calls from members and/or providers regarding appointments.
• Communicate scheduling challenges or trends that may negatively impact quality outcomes.
• Demonstrate sensitivity to issues and show proactive behavior in addressing customer needs.
• Provide ongoing support and education to team members and assist in removing barriers in care.
• Manage time effectively to ensure productivity goals are met.
• Able to work independently in a virtual setting. Able to solve problems, use best professional judgment and apply critical thinking techniques to resolve issues as they arise.
• Identify and seek out opportunities within one's own workflow to improve call efficiency.
• Adhere to corporate requirements related to industry regulations/responsibilities.
• Maintain confidentiality and adhere to HIPAA requirements.
• Data analysis required for multiple system platforms to identify open quality opportunities to address on a member or provider level.
• Appointment coordination for specialist appointments, late refill medication outreach, and scheduling members for local market clinic events.
• Participate within department campaigns to improve overall quality improvements within measure star ratings or contracts.
• Field based activities require the abilities to support appropriate targeted providers.
• Work internally with support team on ad-hoc projects, initiatives, and sprints to address measure star ratings and increase overall measured performance.
• Engage with team on member or provider campaigns which may include documentation tracking, member outreach, data analysis and data entry.
• Support incentive account owners on strategy development, feedback and participate within monthly meetings to give updates on member outreach or quality measure closures.
• Support EMR data exchange initiatives with incentive program owner to establish data communication between provider group and UHC.
• Other duties, as assigned.

Qualifications

• High School Diploma/GED (or higher)
• 1+ years of experience in healthcare background with medical terminology familiarity of clinical issues
• 1+ years of experience in EMR
• 1+ years of experience with HEDIS knowledge
• 1+ years of working experience with Microsoft Tools: Word, Outlook, and Excel (navigating, filtering and analyzing reports)
• 1+ years of working experience with knowledge of HIPAA compliance requirements
• 6+ months of telephonic customer service experience
• Ability to travel within Pittsburgh, PA and surrounding areas to visit provider offices (expectation is up to 75% of the time)
• Active and unrestricted driver's license in your state of residence

Preferred Qualifications

• 1+ years of working experience with ICD-9/10 and CPT Codes
• Experience working in a physician, provider, and/or medical office is preferred
• LPN
• Medical Assistant
• Pharmacy Technician

Soft Skills

• Strong data entry skills, with a typing speed of at least 45-50 WPM
• Demonstrated ability to identify with a consumer to understand and align with their needs and realities
• Demonstrated ability to perform effective active listening skills to empathize with the customer to develop trust and respect
• Demonstrated ability to take responsibility and internally driven to accomplish goals and recognize what needs to be done to achieve a goal(s)
• Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer
• Good Attendance Record

Benefits

Our mission of helping people live healthier lives extends to our team members. Learn more about our range of benefits designed to help you live well.