HEDIS-Star Care Coordinator

POSITION DUTIES & RESPONSIBILITIES

• Effectively communicate with patients and customers so that patients and other healthcare providers receive proper information and follow up in a timely manner.
• Process requests for prescription refill authorizations in a timely manner. Verify compliance with refill clinic protocols and procedures.
• Affords assistance to pharmacists with processing prior authorizations.
• Collaborate effectively with staff from other departments/offices to facilitate safe, appropriate and timely initiation and continuous monitoring of patient care issues for which AZPC is responsible.
• Utilizes clinical record systems to procure and record patient information: Health Plan Systems, NextGen, q.HMO, Business Solutions. Continuously updates patient information provided so that patient records are accurately updated.
• Demonstrate knowledge of when to escalate calls to provider or pharmacist.
• Offer to answer any additional questions that a person, patient, customer may have.
• Support and maintain an environment which fosters high customer and employee satisfaction and quality service.
• Provide assistance and education about preventive health to members that are in accordance to HEDIS/STARS measure education.
• Provide assistance to members, schedule appointments and complete preventive health services in accordance to HEDIS/STARS measures.
• Review medical records and finalize data entry for medical records loaded into q.Metrics and supplemental databases that substantiate Medicare compliance.
• Prepare for three-month auditing period with Health Plan insurance and CMS.
• Perform other duties as assigned.

  Education, Training And Experience

  • High school diploma – Required.
  • College degree preferred.
  • AZPC Medical Assistant or Pharmacy Technician Certification required.
  • Minimum 1 year experience in healthcare or managed care setting with responsibility for systems and/or projects.
  • Knowledge of q.HMO, EzCap and NextGen preferred.
  • Ability to find, gather and collect information or data.
  • Excellent written and oral communication skills.
  • Ability to work independently once oriented to routine and process.
  • Intermediate level proficiency with Microsoft Office applications including Word, Excel, Power Point and Access.

  COMPENSATION

  The hourly range for this position is: $22 – $24.