Your Role

The Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Coordinator will report to the Supervisor of the HEDIS Outreach Team. In this role you will be responsible for conducting provider outreach during the HEDIS season for medical record pursuit and retrieval. Also, participation in Quality initiatives involving member outreach for care gap closure. Responsible for maintaining high productivity and standard work.

Your Work

In this role, you will:

• Conduct warm outreach calls to members and schedule visits with PCP/Specialists. Actively engage and empower members to take action needed to close care gaps for HEDIS compliance
• Request medical records from PCP/Specialists by fax, remote EMR access or scheduled site visits as needed
• Receive and review medical records for content prior to sending for clinical review and abstraction
• Manage and maintain HEDIS files and medical records
• Be an active part of the team and promote a positive work environment
• Prioritize tasks and projects to meet deadlines
• Track projects, accurately enter data, prepare and generate reports
• Provide feedback and regular status reports on assignments
• Provide administrative support, including generating correspondence, organize mass mailings, coordinator schedules and training
• Assist with quality improvement initiatives as needed
• Continued development of understanding of HEDIS hybrid measures and medical record requirements for HEDIS compliance
• Research provider information and claims using online websites and internal applications
• Continuous validation of provider data to ensure the accuracy of the location of medical records accuracy to ensure HEDIS project success.
• Provide input for continual process improvement
• Assist in the current and ongoing assessment of provider office's current practices and provide suggestions for streamlining and/or process improvements
• Works to deliver on day-to-day objectives with direct impact on achievement of results for the job area
• Work consists of tasks that are typically routine, with some deviation from standard practice
• Works under moderate supervision for routine tasks. May seek advice of more senior personnel in the same area
• Other support as requested by leadership

Your Knowledge and Experience

• A high school diploma or equivalent preferred
• Requires basic job knowledge of systems and procedures obtained through prior work experience or education.
• Typically, requires minimum of 3 years of experience. May require vocational or technical education in addition to prior work experience.
• Communication and interpersonal skills
• Must be organized with the ability to keep accurate notes and records
• Customer service experience preferred
• HEDIS knowledge preferred
• Knowledge of computer applications including Microsoft Word, PowerPoint and Excel. Internet knowledge with the ability to complete searches preferred

Pay Range:

The pay range for this role is: $ 18.61 to $ 26.05 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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