Quality Navigator Call Center San Antonio TX
- United States
Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve
your life's best work.(sm)
The Population Health Quality Navigator role is responsible for helping the patients navigate the health care systems, including overcoming social determinants of health and addressing open gaps in care. This role will also reviews medical records to abstract medical data to support HEDIS/STAR and WellMed defined quality measures. This role will verify, update and maintain health related data per operational standard procedures. The primary focus of the role is to help patients optimize their health to the most optimal level and capture all supplemental data available in the Medical Record in order to achieve the highest star score possible.
This is a call center position in San Antonio, TX
- Calls patients via phone to address gaps in health care
- Engage patients over the phone to schedule appointments
- Coordinates use of available resources
- Refer patients as needed to other departments
- Collects data in accordance with HEDIS technical specifications requirements for supplemental data collection
- Review physician progress and encounter notes and identifies specific documentation related to HEDIS/STAR and WellMed defined quality measures
- Adheres to specific data entry requirements
- Verifies patient level account data is acceptable by reviewing, correcting, transmitting, deleting, or reentering specified data
- Participates in system changes, testing and system upgrades by inputting new data and reviewing output with application development teams
- Maintains daily productivity standards
- Faxes request for additional information when needed
- Performs all other related duties as assigned
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
- High School Diploma or GED equivalent required
- Two or more years of related experience required
- Proficiency with Microsoft Office applications to include Word, Excel and Outlook
- Medical terminology knowledge required
- Excellent oral and written communication skills
- Strong attention to detail and excellent organizational skills required
- Must have the ability to multi-task in a fast paced and deadline driven environment
- Must be able to maintain professionalism and a positive service attitude at all times
- Ability to facilitate process completion within specific time parameters
- Certified Medical Assistant training or certification preferred
- Two or more years of experience in a physician's clinic or hospital preferred
- Certified Professional Coder
- Certified healthcare professional
- Clinical work experience; especially in primary care settings
- Ability to lift up to 10 pounds
- Ability to sit for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 380,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Quality Navigator, Patient Navigator, Patient Accounts, Patient Account Representative, Patient Account Rep, Patient Care, Certified Medical Assistant, CMA, Registered Medical Assistant, RMA, Medical Assistant, MA, Certified Professional Coder, CPC, Coder, Coding, Medical Coder, Billing and Coding, WellMed, San Antonio, TX, Texas
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