HEDIS/Risk Outreach Coordinator (bilingual Chinese)
About the role
This position operates on a hybrid work schedule, requiring 3 days onsite at the Huntington Beach office. Clever Care is one of Southern California’s fastest-growing Medicare Advantage plans with 112% year-over-year membership growth. The organization was created to meet the unique needs of diverse communities by combining Western medicine with holistic Eastern practices.
Job Summary
The HEDIS/Risk Outreach Coordinator is responsible for assisting with the deployment and implementation of various Stars and Risk adjustment programs tied to medical records retrieval strategies, collecting and tracking medical records from offices and internal systems within the organization. The coordinator works closely with Stars, Risk, UM/CM, Provider Relations, Member Services and other teams to schedule appointments for members and for scheduling education or retrieval visits with providers, which could be IPA, MSOs, or Physician Offices. The coordinator is also involved with continuous training and education on HEDIS, Stars and Risk Adjustment measures to close gaps in care.
Responsibilities
- Work with the Stars and Risk team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific database
- Facilitate fax or telephone call notification for providers utilizing reports
- Create PowerPoint decks and other training materials for providers and staff
- Collect and compile the required documentation to maintain critical quality improvement functions
- Conduct telephonic and electronic outreach to patients in a HIPAA compliant manner for medication adherence/utilization and other risk/quality gaps closure support, including but not limited to CAHPS and HEDIS/Risk gaps
- Conduct member outreach for quality initiatives including HEDIS or wellness care gaps, medication adherence, member experience, Health Risk assessments, and other quality related outreach campaigns
- May also be required to conduct member outreach from provider office as needed
- Warm transfer of any calls to the vendors per the need of the project
- Identify barriers that prevent patients from closing any gaps and work with care team members to help patients be successful in managing their health
- Coordinate with members of the patient care team, including vendors, providers, pharmacists, nurses, and patient care coordinators to address patient needs
- Perform other duties as assigned
Qualifications
Education and Experience:
- Bachelor's degree or minimum two (2) years' experience in health plan, managed care or equivalent experience
- EMR experience is a plus
- Knowledge of CMS Star Programs, HEDIS, and Risk Adjustment are a plus
- Valid driver's license, reliable transportation, and insurance required with clean driving record
- Must be okay with travel to provider offices
Skills
- Prior experience with project management/coordination and timelines
- Demonstrated effective organizational skills
- Excellent communication, writing, proofreading and grammar skills
- Strong proficiency with MS Word, Excel, PowerPoint
- Excellent organizational skills and attention to detail
- Knowledge of HEDIS technical requirements and HCC Risk Adjustment is a plus
Pay
$20.00 to $25.00 per hour
Schedule & Working Environment
- Hybrid work schedule requiring 3 days onsite at the Huntington Beach office
- Work is performed in an office environment and/or remotely
- May occasionally be required to work irregular hours based on the needs of the business
- Must be able to travel when needed or required
- Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)
- Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs
- Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly
- The job involves frequent contact with staff and public