GENERAL SUMMARY
Facilitates provider and member outreach to ensure member receipt of important clinical services to improvement member health outcomes. Provides support for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives and regulatory/contractual requirements including outreach to members who are noncompliant in the designated outreach services. Supports effective medical record capture for HEDIS medical record review and abstraction of supplemental data.
ESSENTIAL RESPONSIBILITIES
- Identifies potential resources and initiates collaboration with providers to improve member health outcomes and HEDIS measures.
- Makes outbound calls to members to provide assistance in obtaining services (i.e., provide reminders, make appointments, arrange transportation, etc.) to avoid delays in treatment and improve member health outcomes. Identifies when to refer member to Social Worker or Case Manager.
- Develops and distributes educational information to members and providers in accordance with the HEDIS outreach work plan (mailings, social media, automated calls, etc.)
- Assists in the development and standardization of outreach documentation and manages the data flow process to complete HEDIS documentation.
- Documents member participation in outreach activities in accordance with abstraction and audit standards.
- Conducts HEDIS provider chart request calls and mailings.
- May develop and maintain member incentive programs to support HEDIS initiatives. Maintains incentive database to track member compliance.
- May identify opportunities to partner with community organizations on special events and presentations (i.e., health fairs and community events) to heighten awareness of Coventry’s name. Works with internal staff to schedule, organize, and staff these events.
- Records and documents all member and provider outreach activity.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience.
- Previous (3-5 years) outreach experience working with providers or members required.
- Previous experience working with HEDIS criteria.
- Previous experience in a call center environment preferred.
- Strong communication skills and experience speaking with medical providers.
- Ability to work independently.
- Ability to use standard corporate software packages and corporate applications.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
DISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified
Job: Professionals
Primary Location: Louisville, KY, US
Other Locations: Louisville-Kentucky-United States,
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2013-01-31 00:00:00.0
Job ID: 1211046