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Form of workJob Description
HEDIS/ STARS Coordinator
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.
This position works onsite Monday- Friday.
Essential Functions and Duties:
- 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 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 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.
- Performs all other related duties as assigned.
Required qualifications:
- 3 years’ experience in reviewing medical records for data collection, data entry, and quality monitoring including health plan form submission and chart collection activities that close gaps in care
- 2+ years of experience working with HEDIS/STAR measures.
- 1+ years of HEDIS/STAR experience or participation with similar regulatory reporting.
- Experience working in a physician, provider, and/or medical office
- EMR and HEDIS knowledge and experience
Preferred qualifications:
- 2+ years of college, in pursuance of a Bachelor's or Associate's degree in Health Care.
- Licensed Vocational/Registered Nurse, Certified Professional Coder, or Foreign Medical Graduate (FMG/IMG)
- ICD 9/10 and CPT coding experience
Required Languages:
Bilingual (English/Spanish)
This Job Description may be modified at any time at the discretion of the employer as business operation may deem necessary. This does not constitute an employment agreement and may not include all duties. The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with a demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate.
