You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.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.This role will be responsible for ongoing management of quality & Risk Adjustment medical record retrieval. The Clinical Quality Analyst will perform record retrieval with goal to increase HEDIS®, CMS STARs and state - specific measure performance scores by planning, performing, coordinating, and monitoring medical record retrieval activities to meet or exceed quality and Risk standards, contractual requirements and pay for performance incentives.Individual must be highly organized, possess strong leadership skills, with demonstrated professional maturity and emotional resilience. Day to day work varies based on time of year, with overarching goal to increase retrieval of member compliant information resulting in improved HEDIS® or other quality or Risk program rates. The core work during medical record collection includes oversight and completion of medical record retrieval, collaboration with UHG partners and Optum clients as well as line of business representatives or leaders, consultation and cross - collaboration with market quality staff and executives, coordination of contract staff, building and maintaining provider group relationships, understanding and detailed documentation of provider group relationships and medical record retrieval 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.This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00 AM - 5:00 PM CST. It may be necessary, given the business need, to work occasional overtime or weekends.We offer 2 - 4 weeks of paid on-the-job training. The hours of training will be 8:00 AM - 5:00 PM CST from Monday - Friday.All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.Primary Responsibilities:
Overall HEDIS® and other quality and Risk Adjustment program knowledge
Develops 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 retrieval
Understanding of Risk adjustment and additional quality programs such as GRPro to effectively support medical record retrieval 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 retrieval to meet financial and timeline targets which requires the ability to be agile and shift priorities sometimes daily.
Basic understanding of project management concepts such as project scope, project charters, stakeholders, timeliness, and project management tracking tools
Ability to meet timelines associated to project tasks and / or diligence in expressing risks, issues, and dependencies
Builds trust and forms effective relationships with providers and provider group contacts by performing appropriate and professional outreach throughout the year and establishing agreed upon medical record retrieval requirements based on unique provider group preferences
Research and outreach to understand provider group roll ups, i.e., ensuring retrieval 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 Retrieval 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 retrieval 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
Manages unique collection site requirements, and performing retrieval via alternate methods outside of the 7 methodologies as needed including through legal or network contract contacts
Analyze data by running reports, sorting, and formatting data via Excel, and utilizing 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 in regards to handling PHI
Create mailing labels and return mailing labels via UPS Campusship as needed based on group requirements; also, may involve handling PHI according to HIPAA guidelines to route to local UPS store, if needed
Participate in interviewing candidates, as requested by manager
Assist with training via job shadowing, demonstration of tasks and systems, and performing quality checks to ensure they are job ready
Assist with contactors gaining access to electronic medical records systems for remote access retrieval
Work directly with contractor staff by delegating tasks and being available for review, questions, and support
Participate in discussions regarding planning and strategy for hiring and use of contract staff as requested by manager
Effectively and independently operate equipment such as laptop, multiple monitors, scanner, fax, and headset
Utilize multiple systems including 7 different claims systems, medical record retrieval 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
Utilize internal chase management tools, participate in development workgroups, UAT and track issue log tickets as requested by manager
Ability to perform key functions in chase management / retrieval tools in regards to 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 Microsoft Outlook, Microsoft Word, Microsoft OneNote, Microsoft Teams, and Microsoft Excel, specifically performing functions such as vlookups, pivot tables, utilizing multiple filters, etc. in Microsoft 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
Collaboration with stakeholders, market quality departments and across roles within Optum and UHG
Builds trust and forms effective relationships with stakeholders by providing timely operational updates, partnering on issue resolution/mitigation strategies, and monitors resolution of identified issues to conclusion
Collaborate and consult with market quality leadership and other quality roles within UnitedHealth Group to ensure provider group relationships are utilized across roles to complete medical record retrieval in an organized, effective, timely manner as
well as ensure provider abrasion from multiple outreaches doesn’t occur wherever possible.
Participate in state market plan meetings, as needed, and evaluate concerns and present potential solutions to complete successful medical record collection and maintenance of provider relationships
Improvement projects and Workgroup responsibilities
Participate in and potentially lead improvement project and workgroups, as designated by leadership
Present updates to peers on progress of workgroups
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 OR 2+ years of equivalent experience
Must be 18 years of age OR older
4+ years of healthcare industry OR managed care experience
2+ years of direct HEDIS® and / OR RISK Adjustment and / OR medical record review experience
Experience with Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, and work within tables), Microsoft PowerPoint (slide creation), and Microsoft Outlook (email and calendar management)
Ability to work any shift during our normal business hours of 8:00 AM - 5:00 PM CST from Monday - Friday including the flexibility to work occasional overtime or weekends
Preferred Qualifications:
Project management experience
Experience with EMR Remote Access
Experience with using Microsoft Visio and Microsoft SharePoint
Clinical and / OR Health Education experience, such as an RN OR LPN
Experience in 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 to 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 toward 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 amongst direct peers to coordinate and support multiple work efforts
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, Rhode Island, OR Washington, D.C. Residents Only: The hourly range for this is $28.03 - $54.95 per hour. 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.Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.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. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. 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.Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.#RPO
