Note: The job is a remote job and is open to candidates in USA. Astrana Health is seeking a highly motivated Patient Engagement Specialist I in the San Diego area to support their Quality Care Improvement department. The role focuses on outreach to members, assisting with scheduling, and retrieving records to support gap closures in healthcare services.
Responsibilities
- Conduct outreach calls to inform patients of recommended services for HEDIS measure gap closure in a courteous and engaging manner
- Requests and gathers necessary medical records as needed
- Effectively organize projects and tasks based on priority to help meet expectations and deadlines of projects
- Collaborates with the health plan, PCP, and health care team to ensure timely communication of member's clinical information
- Generates letters and faxes to PCPs, Specialists, patients, and other health care team members
- Analytical problem solving with the ability to understand the overall picture
- Coordinate care for patients as appropriate such as scheduling appointments, creating authorizations to facilitate/expedite patient’s requests based on provider’s orders
- Maintain strict confidentiality of business discussions
- Travel to various offices as designated
- Ad-hoc projects as assigned by the manager/supervisor
- May be required to work overtime to meet tight deadlines
- Comply with department policy and procedures
- Collect and collate appropriate data from IPA network providers for HEDIS measures
- Collect medical records, conduct reviews and ensure accuracy of documentation for reporting
- Collect, summarize and trend provider performance data to include provider education
- Participate in ongoing discussions concerning data collections and analysis for HEDIS
- Assist in planning and implementation of projects to improve delivery of services and quality of care
- Understand the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards and HIPAA
- Generate and maintain accurate weekly/monthly/quarterly report of activities
- Attend to health plans, provider, and interdepartmental calls
Skills
- Must reside in San Diego
- Minimum of Associate's degree, Bachelor's degree or equivalent years of experience
- Experience using Microsoft applications such as Word, Excel and Outlook
- Proficiency in electronic scheduling
- At least one (1) year of HEDIS related experience
- Must have Driver's License, reliable transportation and be willing to travel between office locations as needed
- Ability to prioritize and effectively multi-task
- Ability to quickly adapt to various situations
- Excellent organizational skills and strong attention to detail
- Effective and professional communication skills
- Self-driven, quick learner, patient, must be able to work with people of different personalities
- Fluent in Spanish
- 1-3 years of IPA/MSO/HP or general healthcare experience
- Excellent analytical critical reasoning and interpersonal communication skill
- Ability to work in a fast-paced environment
- Ability to keep a high level of confidence and discretion when dealing with sensitive matters relating to providers, members, business plans, strategies and other sensitive information
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