Responsible for coordinating the HEDIS and STARs data gathering process and evaluating the quality and completeness of clinical documentation through medical record reviews. The role supports improvement of clinical documentation processes, identifies trends, maintains review records, and helps ensure all data submitted to the health plan meets HEDIS/Star technical specifications for medical records.
Key responsibilities include reviewing medical records for Star/HEDIS opportunities, supporting data collection and chart collection activities that close gaps in care, partnering with leadership on data mining and special projects, tracking barriers that may affect quality outcomes, assisting with local IRR audits, navigating documentation systems, and supporting the chart chase process by requesting records from provider offices.
- High school diploma or GED
- 3+ years of healthcare experience, including managed care experience
- 3+ years of experience with data analysis and quality chart reviews
- Proficiency with Microsoft Office applications, including databases, word processing, and Excel spreadsheets
- Ability to review data and provide recommendations for improvement
- TB screening required
- Proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis required
Preferred qualifications:
- 2+ years of experience working with HEDIS/STAR measures
- 2+ years of college toward a bachelor’s or associate degree
- Experience with similar regulatory reporting
- ICD-10/11 and CPT coding experience
- Experience working in a physician, provider, or medical office
- EMR and HEDIS knowledge and experience
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase plan
- 401(k) contribution
- Career development opportunities
Location
Florida, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
1 month ago