Clinical STARS Project Specialist (46166) - #1403880
GlobalHealth, Inc.
Date: 2 days ago
City: Oklahoma City, OK
Contract type: Full time
Remote
Description
WHO WE ARE:
GlobalHealth is a fast growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.
Who You Are
Performs tasks associated with STARS and quality initiatives to improve member care. Supports the coordination of data projects and ensures the effective management of care gaps, including data entry, referral tracking and telephonic member and provider outreach.
Essential Job Functions
Supports member engagement projects and outreach performed by the STARS team
Supports the coordination of supplemental and health demographic data collection projects that results in accurately reporting ECDS and other related measures
Performs accurate data entry in HEDIS software system and outreach tracking system.
Reviews and maintains medical records to identify, confirm, and/or document referrals, results, and appropriate medical coding.
Conducts record audits at remote provider offices as needed.
Maintains detailed technical understanding of HEDIS, CAHPS, HOS, Meaningful Use, and Part D measures set by CMS performance standards
Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
Performs other duties as assigned.
Education And Experience
High School diploma or equivalent required
Current Certified/Registered Medical Assistant in State of Oklahoma or 1 year of experience with a health plan or within a quality department or clinical setting required.
Valid state Drivers License, reliable personal vehicle and proof of personal vehicle liability insurance required.
Knowledge, Skills And Abilities
Computer literate and familiar with Microsoft applications (Word, Excel)
Basic electronic health record knowledge and ability to quickly learn new software
Detailed knowledge of quality performance measures and clinical health care
Strong organizational and time management skills
Strong verbal and written communication skills
Working Conditions
Current work environment is remote; however, some state exclusions apply. Must have access to a reliable and secured internet connection source. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure or damage and will adhere to all GlobalHealth privacy and security policies.
Travel
Occasional travel may be required with overnight stays possible
Supervisory Responsibility
This position has no supervisory responsibilities.
Other Duties
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
WHO WE ARE:
GlobalHealth is a fast growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.
Who You Are
Performs tasks associated with STARS and quality initiatives to improve member care. Supports the coordination of data projects and ensures the effective management of care gaps, including data entry, referral tracking and telephonic member and provider outreach.
Essential Job Functions
Supports member engagement projects and outreach performed by the STARS team
Supports the coordination of supplemental and health demographic data collection projects that results in accurately reporting ECDS and other related measures
Performs accurate data entry in HEDIS software system and outreach tracking system.
Reviews and maintains medical records to identify, confirm, and/or document referrals, results, and appropriate medical coding.
Conducts record audits at remote provider offices as needed.
Maintains detailed technical understanding of HEDIS, CAHPS, HOS, Meaningful Use, and Part D measures set by CMS performance standards
Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
Performs other duties as assigned.
Education And Experience
High School diploma or equivalent required
Current Certified/Registered Medical Assistant in State of Oklahoma or 1 year of experience with a health plan or within a quality department or clinical setting required.
Valid state Drivers License, reliable personal vehicle and proof of personal vehicle liability insurance required.
Knowledge, Skills And Abilities
Computer literate and familiar with Microsoft applications (Word, Excel)
Basic electronic health record knowledge and ability to quickly learn new software
Detailed knowledge of quality performance measures and clinical health care
Strong organizational and time management skills
Strong verbal and written communication skills
Working Conditions
Current work environment is remote; however, some state exclusions apply. Must have access to a reliable and secured internet connection source. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure or damage and will adhere to all GlobalHealth privacy and security policies.
Travel
Occasional travel may be required with overnight stays possible
Supervisory Responsibility
This position has no supervisory responsibilities.
Other Duties
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
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