Healthcare - Medical Record Coordinator I

Quality Gap Closure Specialist

MUST LIVE IN MASSACHUSETTS IDEALLY NEAR OR IN WALTHAM, MA AS THERE MAY BE A NEED FOR ONSITE VISITS MONDAY TO FRIDAY 8AM - 5PM EST REQUIRES DUAL MONITORS AND DOCKING STATION MAY BE EXTENDED INTO 2026

Primary duties to support quality gap closure activities. This may include calling providers to request medical records, visiting Massachusetts provider offices onsite to collect medical records, scanning and submitting medical records to appropriate health plan stakeholders, review of in-house available medical records, collaboration with several health plan teams to assist in coordinating efforts, outbound calls to members for gap closure activities, additional travel onsite or other duties as assigned.

Staff are trained to identify care gaps, review available medical records in Epic and CCA systems, request additional medical records via phone and fax, document all efforts and retrieved records in CCA and provide evidence to close care gaps; Staff also make calls during the Q4 push to outreach Non-Utilizers offering a Care Connections visit or assistance scheduling an appointment with their PCP. Staff will outreach PCP offices via phone and fax concerning interventions for OMW, EED and BCS measures. Staff facilitates warm transfers to pharmacy team for members who require medications refills.

Must Have Skills

• Associate's degree or equivalent combination of education and work experience.
• 1-3 years experience in healthcare with minimum 1 year experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience.
• Working knowledge of Quality metrics and risk adjustment practices across all business lines
• Demonstrates data analytic skills
• Operational knowledge and experience with PowerPoint, Excel, Visio
• Effective communication skills
• Strong leadership skills
• Excellent attention to detail, accuracy, and timeliness
• Experience with project management and coordination among several teams

Day To Day Responsibilities

Operationally, the staff performs provider outreach via phone calls and faxes for preventative measures and focuses on BP and HbA1c measures in Q4. The staff facilitates transparency of care gap information via record upload in CCA and "FYI tasks" between Care Connections and SWH NCM. To assist other Molina HEDIS efforts, the staff requests, retrieves and uploads needed medical records into a designated area for Molina abstractors to review. Additional travel onsite or other duties as assigned.

Required Years Of Experience

1-3 years experience in healthcare with minimum 1 year experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience

Required Licensure / Education

Associate's degree or equivalent combination of education and work experience