Summary of Position
• Provide outreach to patients to support HEDIS (Health Effectiveness Data and Information Set), HCC (Hierarchical Conditions
Category), and other quality improvement initiatives implemented to manage population health across all contracted ValueBased Payors.
• Support additional quality and care coordination, HEDIS and HCC related projects/programs including but not limited to
identifying information in the medical record to support gap closure and communicating HEDIS related information to clinical
and administrative staff in the medical offices.
Principal Accountabilities
• Outreach patients telephonically and digitally to schedule appointments including identifying barriers to patient
engagement in making and keeping appointments required to provide appropriate medical care and close HEDIS/HCC
gaps.
• Communicate barriers/ issues to leadership as they present for direction/resolution.
• Maintain productivity metrics required for Charts Reviewed and Appointments Scheduled to review/outreach all
patients assigned.
• Review patient’s chart as needed to determine outreach requirements based on quality and operational strategy
guidelines, processes and workflows.
• Determine next steps based on chart review findings.
• Present complex chart review findings to management for review/ determination of next steps.
• Conduct work essential to supporting outreach efforts, including but not limited to:
• Collect and verify compliance data for reporting and gap closure.
• Document as appropriate, outcome of outreach in EPIC.
• Support all care coordination initiatives based on quality efforts.
• Participate in departmental and corporate meetings and trainings.
• Perform other job-related duties as required.
• Understand and apply HEDIS/HCC specifications to determine next steps as it relates to compliance status and
outreach for our contracted value-based patient population.
• Determine possible cause of issue affecting patient compliance.
• Present issue and possible solution(s) to management for review/ resolution.
Note: There are two roles available
Education, Training, Licenses, Certifications
• High School diploma/GED (R)
• Bachelor’s Degree Preferred (P)
Relevant Work Experience, Knowledge, Skills, and Abilities
• Minimum of two years’ experience in health care setting (R)
• Excellent interpersonal, communication, organization and writing skills with the ability to effectively prioritize work. (R)
• Ability to adjust quickly to change (R)
• Commitment to enhancing patient experience. (R)
• Computer proficiency, with Microsoft Office applications including Word, Excel. (R)
• Knowledge of HEDIS quality measures. (P)
• Minimum of two years’ experience in quality related activities. (P)
• Knowledge of utilizing electronic medical records systems (such as EPIC). (P)