Senior Clinical Practice Performance Coordinator

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Caring. Connecting. Growing together. This role will be responsible for the ongoing management of quality and Risk Adjustment medical record collection. As a Retrieval Associate, you will perform record retrieval with the goal to increase HEDIS®, CMS STARs, and state‑specific measure performance scores by planning, performing, coordinating, and monitoring medical record collection activities to meet or exceed quality and risk standards, contractual requirements, and pay‑for‑performance incentives. Individuals must be highly organized, with demonstrated professional maturity and emotional resilience. Day‑to‑day work mainly involves retrieval via remote EMR access to increase collection of member‑compliant information resulting in improved HEDIS® or other quality or Risk program rates. The core work also includes building and maintaining provider group relationships, understanding and detailed documentation of provider group relationships and medical record collection requirements, as well as mining and reviewing data for project quality assurance. The role requires utilization of multiple claims systems, medical record collection tracking tools, electronic medical record systems, secure FTP, external lab portals, and immunization registries. Primary Responsibilities Overall HEDIS® and other quality and Risk Adjustment program knowledge Develop an understanding of HEDIS® and Risk Adjustment including project timelines to improve HEDIS® scores, CMS Star Ratings, and other metrics Completion of all required measure‑level training to result in an in-depth understanding of the technical specifications of all measures (both hybrid and administrative) to ensure adequate medical record collection Understanding of Risk adjustment and additional quality programs such as GRPro to effectively support medical record collection based on unique components of these projects Understanding of Prospective data collection activities Basic working understanding of billing and claims coding as well as medical record terminology Understanding of HEDIS® or other quality program project progress and results to prioritize collection to meet financial and timeline targets which requires the ability to be agile and shift priorities sometimes daily Ability to meet timelines associated with project tasks and/or diligence in expressing risks, issues, and dependencies Builds trust and form effective relationships with providers and provider group contacts by performing appropriate and professional outreach throughout the year and establishing agreed upon medical record collection requirements based on unique provider group preferences Research and outreach to understand provider group roll ups, i.e., ensuring collection is done at the most proficient level when provider groups have multiple locations and complex group structures Consistently maintain an accurate, detailed and up‑to‑date repository of provider relationships, medical record collection method details and access Medical Record Collection Planning, Management and Performance Attend and participate in weekly team meetings, biweekly team state pod meetings, weekly team huddles, and additional meetings as scheduled to ensure processes, strategies, priorities, tasks, etc. are well understood and concerns, challenges or questions are addressed Develop an in‑depth understanding of multiple collection methods as well as the unique requirements and processes related to each; collection methods include EMR remote access, onsite, remote queued, fax, mail, secure email, and external portal Coordinates and performs medical record collection using one of 7 collection methodologies to support retrieval activities or to investigate gaps in clinical documentation for performance improvement Creates custom request lists based on identified provider group requirements during outreach Ability to sort and format data via Excel, and utilize vlookups, conditional formatting and other technical Excel skills to perform quality checks, data clean up, and further identification of medical record collection details In depth knowledge of and complete adherence to HIPAA guidelines about handling PHI Effectively and independently operate equipment such as laptop, multiple monitors, scanner, fax, and headset Utilize multiple systems including 7 different claims systems, medical record collection tracking tools and electronic medical record systems, secure FTP and lab portals, and immunization registries as well as our secure medical record chart repository, OnBase Ability to perform key functions in chase management/retrieval tools regarding updating provider demographics, multiple levels of provider group collection detail requirements, creating and scheduling requests, modifying requests, and creating, editing and managing provider groupings, etc. Strong Microsoft Office knowledge and skills in Outlook, Word, OneNote, MS Teams, and Excel, specifically performing functions such as vlookups, pivot tables, utilizing multiple filters, etc. in Excel for data mining and organization purposes Knowledge of Adobe Acrobat and ability to combine, split and edit files as well as apply electronic signatures for agreement forms Ability to navigate multiple electronic medical record (EMR) systems to obtain relevant medical records according to quality program and / or HEDIS® measure specifications Required Qualifications High School Diploma/GED 2+ years of healthcare industry OR managed care experience 1+ years of direct HEDIS® and/or RISK Adjustment and/or medical record review experience Intermediate level of proficiency with Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, and work within tables), Microsoft Outlook (email and calendar management), and PowerPoint (slide creation) Ability to travel up to 10% of the time Ability to work full‑time, Monday ‑ Friday, during our normal business hours of 8:00am ‑ 5:00pm, including the flexibility to work occasional overtime based on business need Must be 18 years of age OR older Preferred Qualifications Project management experience Experience with EMR Remote Access Experience using Microsoft Visio and Microsoft SharePoint Clinical and/or Health Education experience, such as an RN OR LPN Experience working with provider offices (clinician and non‑clinicians) Application of continuous quality improvement concepts, such as Six Sigma OR PDSA Telecommuting Requirements Ability to keep all company sensitive documents secure (if applicable) Required to have a dedicated work area established that is separated from other living areas and provides information privacy Must live in a location that can receive a UnitedHealth Group approved high‑speed internet connection or leverage an existing high‑speed internet service Soft Skills Strong, professional, and effective interpersonal and communication skills, both written and verbal Energy, motivation, and commitment to drive results in a challenging, fast‑paced environment Diplomatic with strong negotiation and conflict resolution skills Demonstrated ability to meet commitments, build consensus, negotiate resolutions, and garner respect from other teams Demonstrated ability to assist with focusing activities on a strategic direction and achieve targets / goals Demonstrates adaptability in a highly changing environment, quickly shifting focus as priorities change Presentation skills with ability to present to both peers, leadership, executives, and external stakeholders such as vendors Exhibits creative problem‑solving skills, adapting approach as needed for each engagement Ability to effectively manage time and large workloads Ability to work independently at times with minimal intervention Effective organizational skills Ability to stay on task while working independently in a telecommute setting Ability to work effectively among direct peers to coordinate and support multiple work efforts Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far‑reaching choice of benefits and incentives. The hourly pay for this role will range from $24 – $43 per hour based on full‑time employment. We comply with all minimum wage laws as applicable. We will consider qualified applicants with arrest and conviction records pursuant to the San Francisco Fair Chance Ordinance. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission. Equal Employment Opportunity UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment. #J-18808-Ljbffr University of Minnesota School of Nursing