HEDIS Outreach Specialist


Community Health Group is a locally based non-profit health plan that ensures access to high quality, culturally sensitive health care for underserved communities throughout San Diego County. We treat our 300-member, multi-lingual staff like family, encouraging an atmosphere of collaborative teamwork, continuous learning, personal growth, and promotion from within. Recognized as one of the Top Workplaces in San Diego, CHG offers its employees such benefits as tuition reimbursement, a meditation room and yoga classes, a monthly Breakfast With The CEO, and memorable events throughout the year. 

We know that by serving our employees well, they, in turn, will better serve our nearly 300,000+ membership. We have been recognized consistently for the excellence and sensitivity of our customer service by members, physicians, vendors, and a full range of health care providers. We are accredited by the National Committee for Quality Assurance and proud of our continuing company-wide Quality Initiatives.

We are currently recruiting for:

HEDIS Outreach Specialist

POSITION SUMMARY

Ensures company maintains high standards of patient outcomes and compliance to regulatory requirements by reviewing designated medical records utilizing pre-established criteria.      Provides support to assist in the improvement of HEDIS scores by making outbound calls to identified members and provides necessary documentation.

 

COMPLIANCE WITH REGULATIONS:

Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal.

 

RESPONSIBILITIES

  • Monitors Providers’ Compliance with Regulatory and Company Guidelines by retrieving necessary data from the medical record as directed; locating and processing medical records for review by the medical records abstractor.  Making copies of documents needed to support verification of criteria being reviewed.  Maintaining member and physician confidentiality at all times.

  • Maintains inter – and intra departmental work flow by establishing and maintaining effective communications with internal and external contacts.

  • Annual HEDIS training and successful passing of all hybrid measures.

  • Perform chart review and scanning of medical records for both electronic and paper charts.

  • Input results from chart review into database.

  • Based on report provided on a weekly basis, is responsible for placing a minimum of 45 calls per hour with an expected successful contact of 6 members per hour.

  • Documents all member correspondence into the HEDIS database.

  • Provides appropriate HEDIS correspondence to members as necessary.

  • Identifies operational issues preventing the delivery of good customer service by documenting and referring these to Customer Services management for follow-up and resolution.

  • Maintains product and company reputation and contributes to the team effort by conveying professional image and accomplishing related tasks; participating on committees and in meetings; performing other duties as assigned or requested.

  • Maintains customer confidence and protects company operations by keeping information confidential.

  • Contributes to the team effort by accomplishing related duties as assigned or requested.

     

    Education:                                                              

  • High school diploma or equivalent.

     

     

     

     

    Experience/Skills:

  • Strong customer service background.

  • Medical terminology recommended.

  • Experience with and sensitivity to cultural background and linguistic needs of membership.

  • Familiarity and respect for special social needs of Medi-Cal and Medicare populations.

  • Familiarity with Medi-Cal and Medicare program eligibility and community based organizations.

  • Bilingual English/Spanish required.

  • Excellent communication and interpersonal skills.

  • Ability to exercise mature and independent judgment.

     

    Physical Requirements:

  • Driving within San Diego County

  • Prolonged periods of sitting.

  • Extensive use of telephone. 

  • May be required to work evenings and/or weekends.