HEDIS/STAR Quality Records Coordinator

Texas Health Institute; Plano (TX); On-site; USD 57,308,000 - 103,155,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Job summary

WellMed, part of the Optum family, seeks a Clinical Quality Coordinator to coordinate HEDIS/STAR data gathering, review medical records for quality, and support improvements in documentation processes across practices. You will ensure data meets technical specifications and assist in trend analysis to close care gaps.

In this role, you will mentor staff, maintain HEDIS/STAR knowledge, and navigate multiple systems while supporting chart chase and audits.

Qualifications

• High School diploma or GED.
• Sustained Medical Assistant certification.
• Current BLS certification.
• 3+ years of healthcare experience to include 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.
• 2+ years as a Certified Medical Assistant.
• Experienced using Microsoft Office applications, including databases, word-processing, and excel spreadsheets.
• Knowledge of medical terminology.
• Proven ability to mentor others.
• Proven expert in computer literacy in electronic health record.
• TB screening and immunity requirements.
• Licensed Vocational/Registered Nurse, or Certified Professional Coder.
• 2+ years of college, toward a Bachelor's or Associate's degree
• 2+ years of experience working with HEDIS/STAR measures. ICD 9/10 and CPT coding experience
• 1+ year of HEDIS/STAR experience or participation with similar regulatory reporting
• Experience working in a physician, provider, and/or medical office
• EMR and HEDIS knowledge and experience

Responsibilities

• Assist in review of medical records highlighting STAR/HEDIS opportunities for the medical staff.
• Review 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.

Skills

Data analysis

Quality chart reviews

Microsoft Office

Medical terminology

Mentor others

Electronic health record

Education

High School diploma or GED

Certified Medical Assistant (CMA)

Tools

EMR systems

Job description

WellMed, part of the Optum family, seeks a Clinical Quality Coordinator to coordinate HEDIS/STAR data gathering, review medical records for quality, and support improvements in documentation processes across practices. You will ensure data meets technical specifications and assist in trend analysis to close care gaps.

In this role, you will mentor staff, maintain HEDIS/STAR knowledge, and navigate multiple systems while supporting chart chase and audits.