Clinical Quality Coordinator, Entry

JOB DESCRIPTION
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:

• 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
• Provide project support for member outreach and HEDIS
• Ability to work independently in a fast paced environment

QUALIFICATIONS
Your Knowledge and Experience

• Requires a high school diploma or equivalent
• Requires basic job knowledge of systems and procedures obtained through prior work experience or education.
• Required communication and interpersonal skills
• Must be organized with the ability to keep accurate notes and records
• Required customer service experience
• HEDIS knowledge preferred
• Required critical thinking skills
• Required knowledge of computer applications including Microsoft Word, PowerPoint and Excel. Internet knowledge with the ability to complete searches

Pay Range:

The pay range for this role is: $ 17.41 to $ 24.38 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.

ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California’s top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

• Honest . We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human . We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• Courageous . We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model:

Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That’s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.

Two ways of working: Hybrid (our default) and office

• Hybrid – In a business unit approved office a few times per year to 3 days per week, on average

• Office – In a business unit approved office 4+ days a week, on average. If the role you’re applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.