HEDIS/Risk Outreach Coordinator (bilingual in Vietnamese)

Job Summary

The HEDIS/Risk Outreach Coordinator assists with the deployment and implementation of various Stars and Risk adjustment programs, collects and tracks medical records, facilitates outreach to providers and patients, and conducts member outreach for quality initiatives.

Functions & Job 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 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.
• Collections and compiles the required documentation to maintain critical quality improvement functions.
• Telephonic and electronic outreach to patients for Medication adherence/utilization and other risk/quality gaps closure support including but not limited to CAHPS and HEDIS/Risk gaps.
• Conducts 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.
• Identifies barriers that prevent patients from closing any gaps and works with care team members to help patients be successful in managing their health.
• Coordinates with members of the patient care team, including vendors, providers, pharmacists, nurses, and patient care coordinators to address patient needs.

Qualifications

• Education and Experience: EMR experience is a plus, must be okay with travel to provider offices. Bachelors degree or minimum two (2) years' experience in health plan, managed care or equivalent experience.
• 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.
• 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, Power Point, Excellent organizational skills and attention to detail, Knowledge of HEDIS technical requirements and HCC Risk Adjustment is a plus.

Wage Range

$20 to $25 per hour

Physical & Working Environment

• Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation: 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.
• Work is performed in an office environment and/or remotely.
• The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.