Clinical Quality Coordinator, Entry

Blue Shield of California•Long Beach, CA

2d•Hybrid

About The Position

The Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Coordinator, Entry 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. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Requirements

Requires a high school diploma or equivalent
Requires limited knowledge of systems and procedures
Typically, has limited or no prior experience
Communication and interpersonal skills
Must be organized with the ability to keep accurate notes and records
Knowledge of computer applications including Microsoft Word, PowerPoint and Excel.
Internet knowledge with the ability to complete searches

Nice To Haves

Customer service experience is preferred
HEDIS knowledge strongly preferred
Critical thinking skills

Responsibilities

Initiate outbound calls to members and providers to collect information and provide care coordination assistance in obtaining services (schedule appointments, provider appointment reminders, coordinate transportation, etc.)
Educate members on missing care gaps and provide encouragement to obtain missing service.
Request medical records from PCP/Specialists by fax, remote EMR access or scheduled site visits as needed
Manage and maintain HEDIS files and medical records
Provide administrative support, including generating correspondence, organize mass mailings, coordinator schedules and training
Continued development of understanding of HEDIS hybrid measures and medical record requirements for HEDIS compliance
Research member claims and encounters to identify accurate pursuit information for medical record retrieval
Review medical records and identify elements for compliance
Create and maintain detailed logs of member and provider interactions
Ability to de-escalate situations
Assist in onboarding contingent workforce for HEDIS and outreach projects
EMR and vendor portal medical record retrieval
Developing understanding of HEDIS pursuit processes relative to pursuit systems and tracking processes
Developing understanding of outreach and pursuit project intake procedures, schedules, and reporting requirements
Ability to work independently in a fast-paced environment with minimal errors