Enable America Jobs

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 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.

This is a Hybrid position. It does require field work/ travel up to 50% of the time

Primary 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/WellMed 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/WellMed 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 provider’s 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.

Required Qualifications:

• High School diploma or GED

• 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

• Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets

Preferred Qualifications:

• Licensed Vocational/Registered Nurse, or Certified Professional Coder

• 2+ years of experience working with HEDIS/STAR measures

• 1+ years of HEDIS/STAR experience or participation with similar regulatory reporting

• ICD 9/10 and CPT coding experience

• Experience working in a physician, provider, and/or medical office

• EMR and HEDIS knowledge and experience

Physical & Mental Requirements:

• Ability to lift up to 10 pounds

• Ability to push or pull heavy objects using up to 50 pounds of force

• Ability to stand for extended periods of time

• Ability to use fine motor skills to operate equipment and/or machinery

• Ability to receive and comprehend instructions verbally and/or in writing

• Ability to use logical reasoning for simple and complex problem solving

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.