Senior Clinical Practice Performance Coordinator

Primary Responsibilities

• Overall HEDIS® and other quality and Risk Adjustment program knowledge
• Develops an understanding of HEDIS® and Risk Adjustment including project timelines in order to improve HEDIS® scores, CMS Star Ratings and other metrics
• Completion of all required measure - level training to result in an in depth understanding of the technical specifications of all measures (both hybrid and administrative) to ensure adequate medical record collection
• Understanding of Risk adjustment and additional quality programs such as GRPro to effectively support medical record collection based on unique components of these projects
• Understanding of Prospective data collection activities
• Basic working understanding of billing and claims coding as well as medical record terminology
• Understanding of HEDIS® or other quality program project progress and results to prioritize collection to meet financial and timeline targets which requires the ability to be agile and shift priorities sometimes daily.
• Able to meet timelines associated to project tasks and/or diligence in expressing risks, issues and dependencies
• Builds trust and forms effective relationships with providers and provider group contacts by performing appropriate and professional outreach throughout the year and establishing agreed upon medical record collection requirements based on unique provider group preferences
• Research and outreach to understand provider group roll ups, i.e., ensuring collection is done at the most proficient level when provider groups have multiple locations and complex group structures
• Consistently maintain an accurate, detailed and up to date repository of provider relationships, medical record collection method details and access
• Medical Record Collection Planning, Management and Performance
• Attend and participate in weekly team meetings, biweekly team state pod meetings, weekly team huddles, and additional meetings as scheduled to ensure processes, strategies, priorities, tasks, etc are well understood and concerns, challenges or questions are addressed
• Develop an in depth understanding of multiple collection methods as well as the unique requirements and processes related to each; collection methods include EMR remote access, onsite, remote queued, fax, mail, secure email and external portal
• Covers coordination and performance of medical record collection using one of 7 collection methodologies to support retrieval activities or to investigate gaps in clinical documentation for performance improvement
• Creates custom request lists based on identified provider group requirements during outreach
• Ability to sort and format data via Excel, and utilizing vlookups, conditional formatting and other technical Excel skills in order to perform quality checks, data clean up, and further identification of medical record collection details
• In depth knowledge of and complete adherence to HIPAA guidelines in regards to handling PHI
• Effectively and independently operate equipment such as laptop, multiple monitors, scanner, fax, and headset
• Utilize multiple systems including 7 different claims systems, medical record collection tracking tools and electronic medical record systems, secure FTP and lab portals, and immunization registries as well as our secure medical record chart repository, OnBase
• Able to perform key functions in chase management/retrieval tools in regard to updating provider demographics, multiple levels of provider group collection detail requirements, creating and scheduling requests, modifying requests, and creating, editing and managing provider groupings, etc.
• Strong Microsoft Office knowledge and skills in Outlook, Word, OneNote, MS Teams, and Excel, specifically performing functions such as vlookups, pivot tables, utilizing multiple filters, etc in Excel for data mining and organization purposes
• Knowledge of Adobe Acrobat and ability to combine, split and edit files as well as apply electronic signatures for agreement forms
• Able to navigate multiple electronic medical record (EMR) systems in order to obtain relevant medical records according to quality program and / or HEDIS® measure specifications

Required Qualifications

• High School Diploma / GED OR 2+ years of equivalent experience
• Must be 18 years of age OR older
• 2+ years of healthcare industry OR managed care experience
• 1+ years of direct HEDIS® and/or RISK Adjustment and/or medical record review experience
• Experience with Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, and work within tables) Microsoft Outlook (email and calendar management), and PowerPoint (slide creation)
• Ability to travel up to 10%
• Ability to work full-time, Monday - Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8am - 5pm. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications

• Clinical and / OR Health Education experience, such as an RN OR LPN
• Experience with EMR Remote Access
• Experience in working with provider offices (clinician and non - clinicians)
• Experience with using Microsoft Visio and Microsoft SharePoint
• Project management experience
• Application of continuous quality improvement concepts, such as Six Sigma OR PDSA