In-Field Coordinator (HEDIS)
Company: MetroPlus Health Plan
Posted on: January 15, 2022
About NYC Health + HospitalsMetroPlus Health Plan provides the
highest quality healthcare services to residents of Bronx,
Brooklyn, Manhattan, Queens and Staten Island through a
comprehensive list of products, including, but not limited to, New
York State Medicaid Managed Care, Medicare, Child Health Plus,
Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
As a wholly-owned subsidiary of NYC Health + Hospitals, the largest
public health system in the United States, MetroPlus ' network
includes over 27,000 primary care providers, specialists and
participating clinics. For more than 30 years, MetroPlus has been
committed to building strong relationships with its members and
providers to enable New Yorkers to live their healthiest life.
-Purpose of Position: The primary function of the In-Field
Coordinator is to provide education and training to physicians,
staff and pharmacists at their practice locations and in the
community to ensure compliance with a focus on HEDIS, QARR and
Medicare Advantage Star quality measures. Responsible for
participating in initiatives across a broad array of clinical
measures and health improvement activities. Completes member
outreach and education as needed to ensure members receive
appropriate services. In addition, this position will provide
support and training to physicians on proper coding and medical
record documentation practices to support improvement in quality
metrics. The position may also facilitate referrals to Case
Management to assist with transition of care issues and Customer
Service as needed to address member concerns.The position will be
field based and require travel within the MetroPlus Health Plan
service area. - Job DescriptionMaintain proficiency in MetroPlus
Health Plan Quality programs, HEDIS/QARR measures,
Hybrid/Administrative manuals, MetroPlus Health Plan systems,
Provider Electronic Medical Record systems and utilize this
information to set and meet goals.
- Appropriately utilize provider educational tools to provide
support and training to physicians, provider staff and pharmacists
to ensure compliance with Clinical Practice Guidelines, Preventive
Health guidelines and quality improvement activities to improve the
delivery of quality health care and service to MetroPlus
- Monitor provider-specific HEDIS report cards. With the
guidance, identify areas of concern and address with office
management and/or hospital contacts to initiate improvement.
- Monitor provider/facility progress on monthly basis; prepare
and distribute monthly member gap in care reports and partner with
onsite Medical Management staff to coordinate closure of gaps in
- EMR system review of member gap lists to identify and share
data collection opportunities, coding errors, documentation
shortfalls, appointment timing issues.
- Outreach to MetroPlus members by face-to-face encounters,
telephonically and via other communication venues to provide
education on how to access services, the importance of health
maintenance, preventive health visits and maintaining a
relationship with their PCP.
- Provide or arrange for health education for members with
various diseases such as but not limited to Asthma, Diabetes,
Hypertension, Hypercholesterolemia, Obesity and Heart Disease to
prevent readmission and/or utilizing the emergency room
- Identify noncompliant members that require appointments and
work with the providers to ensure timely member appointments are
obtained. Or, directly set up appointments for MetroPlus health
education initiatives and/or other needed screenings/tests i.e. lab
work, eye, dental exams, etc. via the hospital's scheduling
- Refer potential candidates to on-site facility health education
programs or disease management collaborative as appropriate.
- Document all interventions and telephone encounters with
providers, members, and vendors in the appropriate system in
accordance with established documentation standards for MetroPlus
Health Plan to ensure integrity of member services provided over
the continuum of care and over time.
- Participate in facility and community events or telephonically
outreach to provide MetroPlus members education on how to access
services, the importance of health maintenance, preventive health
visits and maintaining a relationship with their PCP
- Complete on-site provider visits and/or meetings with
admin/claim management on a regular basis to conduct education
sessions regarding appropriate coding practices and medical record
documentation practices. Reviews site coding practices to look for
- Maintain knowledge of medical record review and EMR systems.
Facilitate retrieval of medical record documentation and work with
provider group(s) to retrieve electronic data that supports
HEDIS/QARR. Records findings of patient encounters to include
patient identifiers, relevant information and results.
- May work with community provider offices to facilitate request
and review of charts in support of HEDIS & QARR annually.
- Other duties as assigned by Manager.Minimum Qualifications
- Bachelor 's Degree preferred
- Clinical background: - Health Educator, RN, LPN, or LCSW,
Foreign Medical Graduate (FMG) preferred but not required
- Experience with medical record review working on HEDIS/QARR in
a managed care or health plan setting.
- Prior experience in Quality Improvement in a health care and/or
Managed Care setting strongly preferred.
- An equivalent combination of training, educational background
and experience in related fields and educational disciplines.
- Ability to proficiently read and interpret medical records
- Knowledge of HEDIS specifications required. - - - - - - - - - -
- -Knowledge of ICD-10 and CPT codes preferred.
- Knowledge of Microsoft Office applications including Word,
Excel, PowerPoint, Access and Visio.
- Ability to travel within the MetroPlus service area.
- Experience with relationship management.
- Ability to work in a team setting.
Keywords: MetroPlus Health Plan, Newark , In-Field Coordinator (HEDIS), Other , Newark, New Jersey
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