Quality Coordinator - Houston, TX

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

Job Summary:
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 is full-time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm. Our office is located at HARRIS SUITE #220, 4700 W SAM HOUSTON, TX. 

We offer 3 weeks of paid training. The hours during training will be 8:00 am - 5:00 pm CST from Monday - Friday. After 3 weeks of training it will then to go shadowing.

Primary Responsibilities:

• 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/WellMed 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/WellMed 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.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 

Required Qualifications:

• High School Diploma / GED
• Must be 18 years of age OR older
• 3+ years of healthcare experience to include experience in a managed care setting 
• 3+ years of experience with data analysis / quality chart reviews. Must be able to review data and provide recommendations for improvement
• Experience with using Microsoft office applications, including databases, word-processing, and excel spreadsheets
• Ability to travel up to 25% of their workday within greater Houston, TX area and surrounding areas
• Ability to work between the hours of 8:00 am - 5:00 pm from Monday - Friday

Preferred Qualifications:

• Licensed Vocational / Registered Nurse, OR Certified Professional Coder 
• 1+ years of HEDIS/STAR experience OR participation with similar regulatory reporting 
• 2+ years of college, in pursuance of a Bachelor’s OR Associate’s degree
• 2+ years of experience working with HEDIS/STAR measures 
• ICD 10 and CPT coding experience 
• Experience with working in a physician, provider, and / OR medical office 
• EMR experience 

Physical and Work Environment: (check all that apply)

• Ability to lift up to 10 pounds
• Ability to push OR pull heavy objects using up to 50 pounds of force
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate equipment and / OR machinery
• Ability to properly drive and operate a company vehicle
• Ability to receive and comprehend instructions verbally and / OR in writing
• Ability to use logical reasoning for simple and complex problem solving
• Occasionally requires exposure to communicable diseases OR bodily fluids

The hourly range for this role is $19.86 to $38.85 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.