Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)

WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient's health. WellMed's proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.

This position is responsible for the coordination of HEDIS and STARs data gathering process. This evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, identifying trends, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records.

*Person Must reside in Seminole or Orange County as this is not Telecommute Role

Primary Responsibilities:

• Assisting in the review of medical records to highlight Star / HEDIS opportunities for the medical staff
• Review medical 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

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School diploma or GED
• 3+ years of healthcare experience to include experience in 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
• Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets

Preferred Qualifications:

• Licensed Vocational / Registered Nurse, or Certified Professional Coder
• 1+ years of HEDIS / STAR experience or participation with similar regulatory reporting
• 2+ years of college, in pursuance of a Bachelor's or Associate's degree
• 2+ years of experience working with HEDIS/STAR measures
• ICD 9 / 10 and CPT coding experience
• Experience working in a physician, provider, and / or medical office
• EMR and HEDIS knowledge and experience

If the hired individual resides in Florida (office based or telecommuting) this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five years.

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Quality, Coordinator, Medical Terminology, Auditing, Chart Reviews, Data Mining, PCP Office, HEDIS, Quality, Excel, Computer Skills, FL, Florida, Orlando