Job Description
Job Description
About us:
Solis Health Plans is a new kind of Medicare Advantage company. We provide solutions that are transparent, connected, and effective for both our members and providers. Solis was created with a desire to offer a more personalized experience throughout every stage of the healthcare journey. Our team consists of experts who take pride in delivering quality service. We foster a culture of collaboration and support, where success is shared, and every employee is valued.
To learn more about us, please visit our website at www.solishealthplans.com!
**Position is fully onsite Mon-Friday, Bilingual in ENGLISH & SPANISH or CREOLE is required**
Location: 9250 NW 36th St, Miami, FL 33178.
**Bilingual in English & Spanish or Creole is required**
Full benefits package offered on the first on the month following date of hire including: Medical, Dental, Vision, 401K plan with a 100% company match!
Our company has doubled size and we have experienced exponential growth in membership from 2,000 members to over 10,000 members in the last year!
Join our winning Solis Team!
Position Summary:
This position is responsible for the coordination of HEDIS and STARs data gathering process. This evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, identifying trends, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records. contribute to a positive, patient-centered care experience. This role is essential to improving quality performance, supporting HEDIS and Stars initiatives, and enhancing overall member satisfaction.
Essential Functions and Duties:
· Provide excellent customer service by addressing patients and client needs promptly and courteously.
· Phone calls to patients for scheduling or education on HEDIS Measures.
· Assisting in the review of medical records to highlight Star/HEDIS opportunities for the medical staff.
· Review medical records for data collection, data entry, and quality monitoring including health plan form submission and chart collection activities that close gaps in care.
· Partner with the leadership team, the practice administrative or clinical staff to identify trends observed and potential strategies to support the practice.
· Communicate scheduling challenges or trends that may negatively impact quality outcomes.
· Track and trend barriers/challenges that exist at their assigned groups so that better outcomes can be achieved including access to appointments, lack of follow up on referrals, or inconsistent billing practices.
· Activities may include data collection, data entry, quality monitoring, health plan form submission and chart collection activities.
· Assists with local IRR audits.
· Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures.
· Support chart chase process by requesting records from provider's offices as needed.
· Maintains education/knowledge base of HEDIS/STARs.
· Performs all other related duties as assigned.
Required qualifications:
· High school diploma or equivalent is required.
· 2+ years’ experience working for a Health Plan in reviewing medical records for data collection, data entry, abstraction, overreads and chart collection activities that close gaps in care.
OR
· 2+ years of experience working with HEDIS/STAR measures.
· 2 or more years of HEDIS experience working in a physician, provider, and/or medical office.
· Two (2) or more years of experience proficiency in using electronic medical record (EMR) systems and other healthcare management software. Required.
· Proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook). Required.
· ICD 9/10 and CPT coding experience. Required.
· Excellent verbal communication skills with a customer-focused approach.
Preferred qualifications:
· 2+ years of college, in pursuance of a Bachelor's or Associate's degree in Health Care.
· Licensed Vocational/Registered Nurse, Certified Professional Coder, or Foreign Medical Graduate (FMG/IMG).
Required Languages:
Bilingual English & Spanish or Creole.
What set us apart:
Join Solis Health Plans as a HEDIS/Stars Coordinator and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference.