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Physician / Internal Medicine / Texas / Locum or Permanent / Clinical Quality Coordinator USMD Clinical Excellence Specialist
2 months ago
Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.
This position is responsible for the coordination of HEDIS and STARs data gathering process.
This evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, identifying trends, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records.
Key Responsibilities:
Assisting in the review of medical records to highlight Star / HEDIS opportunities for the medical staff
Review medical records for data collection, data entry, and quality monitoring including health plan / OptumCare form submission and chart collection activities that close gaps in care
Partner with the leadership team, the practice administrative or clinical staff to identify trends observed and potential strategies to support the practice
Communicate scheduling challenges or trends that may negatively impact quality outcomes
Track and trend barriers/challenges that exist at their assigned groups so that better outcomes can be achieved including access to appointments, lack of follow up on referrals, or inconsistent billing practices
Activities may include data collection, data entry, quality monitoring, health plan / OptumCare form submission and chart collection activities
Assists with local IRR audits
Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS / Star measures
Support chart chase process by requesting records from providers offices as needed
Maintains education/knowledge base of HEDIS / STARs
Performs all other related duties as assigned
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.
