LVN/LPN Primary Source Verification Specialist San Antonio Texas
1 week ago
Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.
This position is responsible for the Primary Source Verification process and coordination of HEDIS and STARs data gathering process within the eCW and DataRaps applications. This role evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records.
Primary Responsibilities:
- Analyze data, evaluate for possible data integrity and data deficits and document findings
- Over reads the data entry of non-standard supplemental data obtained from medical record review
- Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures
- Review of scanned records and data entry into DataRaps application
- Support chart chase process by requesting records from provider's offices as needed
- Supports and improves communications between market and corporate departments
- Maintains education/knowledge base of HEDIS/STARs standards and guidelines
- Performs all other related duties as assigned
This is an office-based position near IH 10 W.
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- Licensed Vocational/Professional Nurse
- 3+ years of healthcare experience to include experience in a managed care setting
- 3+ years of experience with data analysis/quality chart reviews. Must be able to review data and provide recommendations for improvement
- HEDIS/STAR experience or participation with similar regulatory reporting
- Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets
Preferred Qualifications:
- 2+ years of college, in pursuance of a Bachelor's or Associate's degree
- 2+ years of experience working with HEDIS/STAR measures
Physical & Mental Requirements:
- Ability to push or pull heavy objects using up to pounds of force
- Ability to properly drive and operate a company vehicle
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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