HEDIS Medical Record Collector

Job Title:

HEDIS Medical Record Collector

Location:

Remote, OH

Shift: M-F, 8: 00a-5: 00p, Eastern

Contract:

3+ (possible extension or conversion)

Job Description:

Primary duties to support and project manage ongoing audit activities. This may include calling providers to request medical records, visiting Ohio provider offices onsite to collect medical records, scanning and submitting medical records to appropriate health plan stakeholders, detailed tracking and reporting of medical record collection efforts and completion aligned with health plan-provided target list, collaboration with several health plan teams to assist in coordinating efforts, additional travel onsite or other duties as assigned.

The Provider Engagement Specialist role implements Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures the smaller, less advanced Tier 2 and Tier 3 providers have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through regular meetings and action plans.

Addresses practice environment challenges to achieve program goals and improve health outcomes. Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for the Provider Engagement team. Communicates effectively with healthcare professionals and maintains compliance with policies.

• Associate’s degree or equivalent combination of education and work experience.
• 1-3 years experience in healthcare with minimum 1 year experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience.
• Working knowledge of Quality metrics and risk adjustment practices across all business lines
• Demonstrates data analytic skills
• Operational knowledge and experience with PowerPoint, Excel, Visio
• Effective communication skills
• Strong leadership skills
• Excellent attention to detail, accuracy, and timeliness
• Experience with project management and coordination among several teams

Primary duties to support and project manage ongoing audit activities. This may include calling providers to request medical records, visiting Ohio provider offices onsite to collect medical records, scanning and submitting medical records to appropriate health plan stakeholders, detailed tracking and reporting of medical record collection efforts and completion aligned with health plan-provided target list, collaboration with several health plan teams to assist in coordinating efforts, additional travel onsite or other duties as assigned.

Required Years of

Experience:

1-3 years experience in healthcare with minimum 1 year experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience

Required Licensure /

Education:

Associate’s degree or equivalent combination of education and work experience