Job Description

Job Description:

Functions & Job Responsibilities

• Candidate will work with the Stars and Risk team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific database.
• Facilitate fax or telephone call notification for providers utilizing reports.
• Create PowerPoint decks and other training materials for providers and staff.
• Collects and compiles the required documentation to maintain critical quality improvement functions.

Telephonic and electronic outreach to patients

• HIPAA compliant outreaches to patients for Medication adherence/utilization and other risk/quality gaps closure support including but not limited to CAHPS and HEDIS/Risk gaps.
• Conducts member outreach for quality initiatives including HEDIS or wellness care gaps, medication adherence, member experience, Health Risk assessments, and other quality related outreach campaigns.
• May also be required to conducts member outreach from provider office as needed.
• Warm transfer of any calls to the vendors per the need of the project.
• Identifying barriers that prevent patients from closing any gaps and work with care team members to help patients be successful in managing their health.
• Coordinate with members of the patient care team, including vendors, providers, pharmacists, nurses, and patient care coordinators to address patient needs.
• Other duties as assigned.

Qualifications

Education and Experience:

• EMR experience is a plus, must be okay with travel to provider offices.
• Minimum two (2) years' experience in health plan, managed care or equivalent experience.
• Knowledge of CMS Star Programs, HEDIS is a plus.
• Valid driver’s license, reliable transportation, and insurance required with clean driving record

Skills:

• Prior experience with project coordination and timelines
• Demonstrated effective organizational skills.
• Excellent communication, writing, proofreading and grammar skills
• Strong proficiency with MS Word, Excel, Power Point
• Excellent organizational skills and attention to detail
• Knowledge of HEDIS technical requirements is a plus

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