Quality Care Coordinator
2 months ago
Minimum Experience: A minimum of three plus (3+) years of IPA/HMO experience and one plus (1+) year/s in P4P/HCC/CMS Star Programs experience. Ability to project excellent customer service, negotiation, and conflict resolution skills via telephone while maintaining a professional demeanor.
Req. Certification/Licensure: None.
- Manage assigned member outreach (appointment calls, quality measures due, annual wellness visits, follow-up calls, etc.) by closing gaps in care and increase HEDIS/IHA/STAR/P4P scores.
- Receive inbound calls from members and assist with tracking data, etc.
- Document details the healthcare provider conducts in quality platforms (Cozeva, etc) communication module for accurate tracking.
- Provide general education to encourage the staff and providers to complete the required, "due" quality measures.
- Input alerts in EMR to notify providers/staff of current outstanding items due for completion.
- Develop and maintain the P4P and HEDIS training manual and documentation in accordance with department standards and industry best practices
- Assist the Manager in the coordination and preparation of the HEDIS medical record review, which includes outgoing review of records submitted by providers and the annual HEDIS medical record review.
- Provide the providers, staff, and members with the nearest contracted Lab location to have lab services rendered.
- Assist as needed in support of accreditation activities such as NCQA reviews, CAHPS, and state audits.
- Ability to create CMS1500 forms from the provider code data
- Ability to discuss with providers the strengths and weakness while coding
- Request medical records from healthcare providers to verify services were rendered, per member's verbal reporting.
- Follow all departmental Policies and Procedures for audit compliancy.
- Assists outside departments with facilitating PCP transfers, answering questions, and conducting follow-up calls; as needed.
- Populate database with new member demographic information.
- Helps with special projects, as needed.
- Manage assigned member outreach (appointment calls, quality measures due, annual wellness visits, follow-up calls, etc.) by closing gaps in care and increase HEDIS/IHA/STAR/P4P scores.
- Receive inbound calls from members and assist with tracking data, etc.
- Document details the healthcare provider conducts in quality platforms (Cozeva, etc) communication module for accurate tracking.
- Provide general education to encourage the staff and providers to complete the required, "due" quality measures.
- Input alerts in EMR to notify providers/staff of current outstanding items due for completion.
- Develop and maintain the P4P and HEDIS training manual and documentation in accordance with department standards and industry best practices
- Assist the Manager in the coordination and preparation of the HEDIS medical record review, which includes outgoing review of records submitted by providers and the annual HEDIS medical record review.
- Provide the providers, staff, and members with the nearest contracted Lab location to have lab services rendered.
- Assist as needed in support of accreditation activities such as NCQA reviews, CAHPS, and state audits.
- Ability to create CMS1500 forms from the provider code data
- Ability to discuss with providers the strengths and weakness while coding
- Request medical records from healthcare providers to verify services were rendered, per member's verbal reporting.
- Follow all departmental Policies and Procedures for audit compliancy.
- Assists outside departments with facilitating PCP transfers, answering questions, and conducting follow-up calls; as needed.
- Populate database with new member demographic information.
- Helps with special projects, as needed.
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