Provider Engagement Coordinator HEDIS - CenterWell, Kansas City
Humana

Job Info

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Description

The Provider Engagement Coordinator 2 develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Provider Engagement Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Responsibilities

HEDIS Coordinator will be responsible for insuring target HEDIS measures are being met, reviewing patient charts, submitting necessary records, alert home visits, identify patients that need eye exam and identify gaps in the HEDIS process. The HEDIS Coordinator works and communicates in a positive, cooperative, considerate and caring manner with patients and clinic staff when providing information and services, when seeking assistance and when clarifying and resolving problems or improving workflow.

Essential Functions and Duties

•Obtain HEDIS open gaps report weekly or whenever list is posted

•Pull from portals (Freedom and Optimum 2x/month) provider scores first (to learn weak areas - eye exam, cancer screening etc.), and all measures required

•Look for measures with low dominator to target

•Assists clinic staff to Upload files on portals for clinics and also help uploading the reports.

•Communicate with office MAs to target members with open gaps during office visit

•The HEDIS coordinator must be part of the HEDIS GAPS meetings scheduled with the health plans reps. for the office HEDIS meeting.

•Identify the patients with BCS, COL, EYE EXAM, NPH HEDIS Gaps and submit the reports found after a chart review

•Communicate with clinic staff regarding open gaps, medication refills and referral to specialists.

•Assist the clinics in schedule appointments with at home diagnostics in extreme situation to close gaps.

•The HEDIS coordinator will request the list of the patients with HbA1c ordered and will review the result to assure compliance with the DM HbA1c < 9% and she will monitor the actions taken by clinic staff for those patients with poor results (>9%)

•Pull from portals (Freedom and Optimum 2x/month) provider scores first (to learn weak areas - eye exam, colon etc.), and measures required

•Follow up weekly with clinic staff to see that measure has been completed

•Alert home visiting team on open gaps of care prior to home visit

•STAR coordinator will either send actions of phone notes for clinic staff for critical measures or measures that require issuing referral orders by provider.

•In charge of any HEDIS events scheduling like mobile eye exam. Mobil mammogram for coordination of schedule with clinic center administrator and be on site for these events.

•Assist in mobile events and be at the clinic if needed to coordinate patient care and compliance with other measures as A1C measure, handing and education of stool cards with staff during the events.

•Train on the use of the retinal camera to perform the measure on site If becomes available.

•On location or virtual staff training for new and existing clinical staff

•Make sure office staff have access to different health plans portal and facilitate the registry process.

•Follow up on the use of portals by distributing users log to CA for adherence or lack of.

•Review list of hospital follow up members to insure hospital records are in chart and if not, request mailed to census management to obtain records.

•Attend health plans monthly HEDIS meeting whenever she is available.

Part D Compliance:

•Medication Adherence review using the information provided by Rx Effect, Well Care, Freedom and Optimum portals in a weekly basis along with the Part D reports released from Care Plus: Make sure 90 days prescription;

•Will assist clinic MA in reviewing meds adherence list alert providers to 30 day conversion and guide and assists if possible clinic staff to contact pharmacy for inactive medications and Contact patients to pick up prescription from pharmacy

•To check the daily Hospital discharge list and verify NOV and Hospital records included the Medication's list to do a medication reconciliation between the 30 days after discharge.

•Help clinical staff fill prescription under provider guidance if agreeable by provider.

•Able to read part D reports and educate clinic staff on how to target members with low medication compliance.

Required Qualifications

• 1 - 3 years of administrative, operations support or customer service experience
  
• Proficiency with Microsoft Word, Excel, etc.
  
• Strong oral and written communications skills
  
• Ability to meet deadlines in a fast-paced environment
  
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
  
• Communication skills in talking to patients
  
• Knowledge of scheduling patients
  
• Availability to travel to different offices for specific projects
  

Preferred Qualifications

• Medical Assistant Certification from AMT, AAMA, NCCT, NHA required.
  
• Strong preferred: 2-3 years of HEDIS experience
  
• Experience with all duties of a medical assistant, such as drawing blood, taking blood pressure, simple patient education.
  

Additional Information

This role will work out of our Overland Park location; but there will be a need for the person in this role to rotate to all of our 8 locations in the Kansa City Market.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours

40

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