Coord HEDIS Nonclinical

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

Under the direction of the Lead HEDIS Reviewer, the HEDIS Coordinator is responsible for:

• Participating in and providing guidance and support for the development and maintenance of the HEDIS Medical Record Review platform(s) to support all plans.
• Coordinating the ongoing medical record collection and archiving of documents that support medical record review projects, regulatory audits, and accreditation standards.
• Working collaboratively within the department to maintain SharePoint site, drives, medical records, blogs, newsletters and other program and project materials as deemed necessary.
• Participating in and providing support for process improvement initiatives with the medical record review process across the enterprise.
• Coordinating meeting calendars, facilitating meetings as directed, and participating in appropriate meetings including note taking and materials distribution.
• Filing copy company invoices, printing pull lists from medical record review tools and saving to appropriate locations per defined process(es).
• Pulling incoming medical records from the fax and email queues and saving to appropriate locations per defined process(es).
• Scanning incoming medical records received via mail or onsite visit and saving to appropriate locations per defined process(es).
• Outreaching providers to support HEDIS and other medical record review projects to include but not limited to: validation of fax numbers, provider office locations, HEDIS contact information, scheduling of onsite retrieval appointments; maintenance and follow-up for pull lists and investigation into additional documentation requirements.
• Developing and maintaining expertise in the requirements and parameters of mandated HEDIS and State performance measures.
• Performing and applying structured auditing abstraction criteria to medical records to determine compliance for measures as directed.
• Maintaining an abstraction proficiency rate of 95% by correctly reading, interpreting, and abstracting various components of the medical record such as notes, consultations, medication forms, treatment plans, health history, interval history, and past history.
• Assisting in the medical record collection process including making phone calls, sending out faxes/letters or chart retrieval to providers as assigned.
• Ability to analyze data including statistical analyses. Ability to analyze practices, identify trends and make recommendations for improvement of practice and processes related to Medical Record Retrieval and HEDIS. Recommends and implements program improvements that strengthen the MRR process and be able to present in a written report.
• Reviewing applicable/assigned Roadmap sections for accuracy.
• Completing additional designated projects assigned and deemed as necessary.
  
  

Education/Experience:

• High School/GED.
• Associate’s Degree preferred but not required.
• 1 to 3 years demonstrated expertise in project coordination, office management, medical record collection, medical terminology, call center creating and managing central data repositories and data management systems for an office or large department.
• Knowledge of medical terminology and basic charting.
• Experience with Outlook, Excel, Power Point, Word, and Share Point.
• Strong written and oral communication skills, critical thinking skills, strong organizational skills.
• Able to think and work independently, effectively, and under pressure of deadlines.
• Ability to function effectively within multidisciplinary teams.
• Ability to accurately complete tasks within established times.
• Ability to effectively prioritize multiple tasks and deadlines.
  
  

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.