Senior Clinical Practice Coordinator| Dallas, TX | Remote

Senior Clinical Practice Performance Coordinator

This position is national remote. You'll enjoy the flexibility to telecommute
* from anywhere within the U.S. as you take on some tough challenges.

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives?

Join us to start Caring. Connecting. Growing together.

This role will be responsible for ongoing management of quality & Risk Adjustment medical record collection. Senior Clinical Practice Performance Coordinator will perform record retrieval with goal to increase HEDIS®, CMS STARs and state-specific measure performance scores by planning, performing, coordinating and monitoring medical record collection activities to meet or exceed quality and Risk standards, contractual requirements and pay for performance incentives.

Individual must be highly organized, with demonstrated professional maturity and emotional resilience. Day to day work mainly involves retrieval via remote EMR access to increase collection of member compliant information resulting in improved HEDIS® or other quality or Risk program rates. The core work also includes building and maintaining provider group relationships, understanding and detailed documentation of provider group relationships and medical record collection requirements, as well as mining and reviewing data for project quality assurance.

The role requires utilization of multiple claims systems, medical record collection tracking tools, electronic medical record systems, secure FTP, external lab portals, and immunization registries.

This position is 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.

We offer 4 weeks of on-the-job training. The hours of training will be aligned with your schedule.

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.
• Ability 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…