Field-Based Senior Practice Performance Specialist in Pittsburgh, PA

UnitedHealth Group•Pittsburgh, PA

18h•Hybrid

About The Position

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. Employees in this position will work on-site or virtually as an extension of the local quality and provider teams by aligning geographical regions, medical centers and/or physician practices that manage a high volume of UHC Medicare & Retirement membership. As a Senior Practice Performance Consultant, you will be responsible for partnering with practice admin or clinical staff to review medical records and help close HEDIS gaps in care for Medicare members. This position does not entail any direct member care nor does any case management occur. This is a field-based position based in Pittsburgh, PA and surrounding areas. If you reside within Pittsburgh PA, you will enjoy the flexibility to telecommute as you take on some tough challenges.

Requirements

High School Diploma/GED (or higher)
1+ years of experience in healthcare background with medical terminology familiarity of clinical issues
1+ years of experience in EMR
1+ years of experience with HEDIS knowledge
1+ years of working experience with Microsoft Tools: Word, Outlook, and Excel (navigating, filtering and analyzing reports)
1+ years of working experience with knowledge of HIPAA compliance requirements
6+ months of telephonic customer service experience
Ability to travel within Pittsburgh, PA and surrounding areas to visit provider offices (expectation is up to 75% of the time)
Active and unrestricted driver’s license in your state of residence

Nice To Haves

1+ years of working experience with ICD- 9/10 and CPT Codes
Experience working in a physician, provider, and/or medical office is preferred
LPN
Medical Assistant
Pharmacy Technician
Strong data entry skills, with a typing speed of at least 45-50 WPM
Demonstrated ability to identify with a consumer to understand and align with their needs and realities
Demonstrated ability to perform effective active listening skills to empathize with the customer to develop trust and respect
Demonstrated ability to take responsibility and internally driven to accomplish goals and recognize what needs to be done to achieve a goal(s)
Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer
Good Attendance Record

Responsibilities

Partner with your leadership team, the practice administrative or clinical staff to determine the best strategies to support the practice and our members ensuring that recommended preventative health screenings are completed and HEDIS gaps in care are addressed
Functioning independently, virtually meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members
Execute applicable provider incentive programs for health plan
Assist in the review of medical records to highlight Star opportunities for the medical staff
Activities include data collection, data entry, quality monitoring, upload of images, and chart collection activities
Locate medical screening results/documentation to ensure quality measures are followed in the closure of gaps. Will not conduct any evaluation or interpretation of Clinical data
Track appointments and document information completely and accurately in all currently supported systems in a timely manner
Optimize customer satisfaction, positively impact the closing of gaps in care and productivity
Interaction with UHC members via telephone to assist and support an appropriate level of care. This may include making outbound calls to members and/or providers to assist in scheduling appointments, closing gaps in care or chart collection activities
Answer inbound calls from members and/or providers regarding appointments
Communicate scheduling challenges or trends that may negatively impact quality outcomes
Demonstrate sensitivity to issues and show proactive behavior in addressing customer needs
Provide ongoing support and education to team members and assist in removing barriers in care
Manage time effectively to ensure productivity goals are met
Ability to work independently in virtual setting. Ability to solve problems, use best professional judgment and apply critical thinking techniques to resolve issues as they arise
Identify and seek out opportunities within one’s own workflow to improve call efficiency.
Adhere to corporate requirements related to industry regulations/responsibilities
Maintain confidentiality and adhere to HIPAA requirements
Data analysis required for multiple system platforms to identify open quality opportunities to address on a member or provider level
Appointment coordination for specialist appointments, late to refill medication outreach and scheduling members for local market clinic events
Participate within department campaigns to improve overall quality improvements within measure star ratings or contracts
Field based activities require the abilities to support appropriate targeted providers.
Work internally with support team on ad-hoc projects, initiatives, and sprints to address measure star ratings and increase overall measured performance
Participate and engage with team on member or provider campaigns which may include documentation tracking, member outreach, data analysis and data entry
Support incentive account owners on strategy development, feedback and participate within monthly meetings to give updates on member outreach or quality measure closures
Support EMR data exchange initiatives with incentive program owner to establish data communication between provider group and UHC
Other duties, as assigned