Job Description

Job Responsibilities:

• Supports effective medical record capture for HEDIS medical record review and abstraction of supplemental data.
• Performs provider/location research, clean up, and data updates to ensure that medical record requests are submitted to the right location and PHI is properly handled
• Conducts HEDIS provider chart request calls, faxes, and mailings.
• Identifies potential resources and initiates collaboration with providers to improve member health outcomes and HEDIS measure rates
• Facilitates provider and member outreach to ensure member receipt of important clinical services to improve member health outcomes and close gaps in care.
• Identifies when to refer member to Social Worker or Case Manager.
• Assists in the development and standardization of outreach documentation and manages the data flow process to complete HEDIS documentation.
• Documents member participation in outreach activities in accordance with abstraction and audit standards.
• Records and documents all members and provide outreach activity.

Skills:

• Minimum 1 year, recent HEDIS project support-related experience
• Strong communication skills and experience speaking with medical providers.
• Ability to use standard corporate software packages and corporate applications.
• Computer skills: Microsoft Word, Excel, Outlook, Teams, Adobe Reader, RightFax
• Recent and related experience working in health care marketing, member outreach and/or health education experience.
• Experience working in call center environment

Education/Experience:

• Associate degree or equivalent experience

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