Our Client, a Retail Pharmacy company, is looking for a HEDIS Outreach Coordinator for their Remote location.
Responsibilities:
Provides support for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives and regulatory/contractual requirements including outreach to members who are noncompliant in the designated outreach services.
Supports effective medical record capture for HEDIS medical record review and abstraction of supplemental data.
Performs provider/location research, clean up, and data updates to ensure that medical record requests are submitted to the right location and PHI is properly handled
Conducts HEDIS provider chart request calls, faxes, and mailings.
Identifies potential resources and initiates collaboration with providers to improve member health outcomes and HEDIS measure rates
Facilitates provider and member outreach to ensure member receipt of important clinical services to improve member health outcomes and close gaps in care.
Identifies when to refer member to Social Worker or Case Manager.
Assists in the development and standardization of outreach documentation and manages the data flow process to complete HEDIS documentation.
Documents member participation in outreach activities in accordance with abstraction and audit standards.
Records and documents all member and provider outreach activity.