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Quality Coordinator - with 25% Local Travel - 2228565

UnitedHealth Group

UnitedHealth Group

Quality Assurance
Fort Worth, TX, USA · Gainesville, TX, USA · Denton, TX, USA · Bridgeport, TX, USA · Decatur, TX, USA · Lewisville, TX, USA
Posted on Sunday, June 9, 2024

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

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
  • 1+ years of HEDIS/STAR experience or participation with similar regulatory reporting
  • 2+ years of experience working with HEDIS/STAR measures
  • ICD 9/10 and CPT coding experience
  • Experience working in a physician, provider, and/or medical office
  • EMR and HEDIS knowledge and experience

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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.