Retrieval Associate – National Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

This role will be responsible for ongoing management of quality & Risk Adjustment medical record collection. Retrieval Associate will perform record retrieval with goal to increase HEDIS®, CMS STARs and state – specific measure performance scores by planning, performing, coordinating and monitoring medical record collection activities to meet or exceed quality and Risk standards, contractual requirements and pay for performance incentives.   

Individual must be highly organized, with demonstrated professional maturity and emotional resilience. Day to day work mainly involves retrieval via remote EMR access to increase collection of member compliant information resulting in improved HEDIS® or other quality or Risk program rates. The core work also includes building and maintaining provider group relationships, understanding and detailed documentation of provider group relationships and medical record collection requirements, as well as mining and reviewing data for project quality assurance.  The role requires utilization of multiple claims systems, medical record collection tracking tools, electronic medical record systems, secure FTP, external lab portals, and immunization registries.

This position is full time. Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am – 5 pm. It may be necessary, given the business need, to work occasional overtime.  

We offer 4 weeks of on-the-job training. The hours of the training will be aligned with your schedule.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

 

Primary Responsibilities:

• Overall HEDIS® and other quality and Risk Adjustment program knowledge
• Develops an understanding of HEDIS® and Risk Adjustment including project timelines in order to improve HEDIS® scores, CMS Star Ratings and other metrics
• Completion of all required measure – level training to result in an in depth understanding of the technical specifications of all measures (both hybrid and administrative) to ensure adequate medical record collection
• Understanding of Risk adjustment and additional quality programs such asGRPro to effectively support medical record collection based on unique components of these projects
• Understanding of Prospective data collection activities
• Basic working understanding of billing and claims coding as well as medical record terminology
• Understanding of HEDIS® or other quality program project progress and results to prioritize collection to meet financial and timeline targets which requires the ability to be agile and shift priorities sometimes daily.
• Ability to meet timelines associated to project tasks and/or diligence in expressing risks, issues and dependencies
• Builds trust and forms effective relationships with providers and provider group contacts by performing appropriate and professional outreach throughout the year and establishing agreed upon medical record collection requirements based on unique provider group preferences
• Research and outreach to understand provider group roll ups, i.e., ensuring collection is done at the most proficient level when provider groups have multiple locations and complex group structures
• Consistently maintain an accurate, detailed and up to date repository of provider relationships, medical record collection method details and access
• Medical Record Collection Planning, Management and Performance
• Attend and participate in weekly team meetings, biweekly team state pod meetings, weekly team huddles, and additional meetings as scheduled to ensure processes, strategies, priorities, tasks, etc are well understood and concerns, challenges or questions are addressed
• Develop an in depth understanding of multiple collection methods as well as the unique requirements and processes related to each; collection methods include EMR remote access, onsite, remote queued, fax, mail, secure email and external portal
• Coordinates and performs medical record collection using one of 7 collection methodologies to support retrieval activities or to investigate gaps in clinical documentation for performance improvement
• Creates custom request lists based on identified provider group requirements during outreach
• Ability to sort and format data via Excel, and utilizing vlookups, conditional formatting and other technical Excel skills in order to perform quality checks, data clean up, and further identification of medical record collection details
• In depth knowledge of and complete adherence to HIPAA guidelines in regards to handling PHI
• Effectively and independently operate equipment such as laptop, multiple monitors, scanner, fax, and headset
• Utilize multiple systems including 7 different claims systems, medical record collection tracking tools and electronic medical record systems, secure FTP and lab portals, and immunization registries as well as our secure medical record chart repository, OnBase
• Ability to perform key functions in chase management/retrieval tools in regard to updating provider demographics, multiple levels of provider group collection detail requirements, creating and scheduling requests, modifying requests, and creating, editing and managing provider groupings, etc.
• Strong Microsoft Office knowledge and skills in Outlook, Word, OneNote, MS Teams, and Excel, specifically performing functions such as vlookups, pivot tables, utilizing multiple filters, etc in Excel for data mining and organization purposes
• Knowledge of Adobe Acrobat and ability to combine, split and edit files as well as apply electronic signatures for agreement forms
• Ability to navigate multiple electronic medical record (EMR) systems in order to obtain relevant medical records according to quality program and / or HEDIS® measure specifications

 

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. 

Required Qualifications:

• High School Diploma / GED OR 2+ years of equivalent experience
• Must be 18 years of age OR older
• 2+ years of healthcare industry OR managed care experience
• 1+ years of direct HEDIS® and/or RISK Adjustment and/or medical record review experience
• Experience with Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, and work within tables) Microsoft Outlook (email and calendar management), and PowerPoint (slide creation).
• Ability to travel up to 10%
• Ability to work full time. Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am – 5 pm. It may be necessary, given the business need, to work occasional overtime.  

 

Preferred Qualifications:

• Clinical and / OR Health Education experience, such as an RN OR LPN
• Experience with EMR Remote Access
• Experience in working with provider offices (clinician and non – clinicians)
• Experience with using Microsoft Visio and Microsoft SharePoint
• Project management experience
• Application of continuous quality improvement concepts, such as Six Sigma OR PDSA

 

Telecommuting Requirements: 

• Ability to keep all company sensitive documents secure (if applicable) 
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy. 
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service. 

 

Soft Skills:

• Strong, professional, and effective interpersonal and communication skills, both written and verbal
• Energy, motivation, and commitment to drive to results in a challenging, fast – paced environment
• Diplomatic with strong negotiation and conflict resolution skills
• Demonstrated ability to meet commitments, build consensus, negotiate resolutions, and garner respect from other teams
• Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets / goals
• Demonstrates adaptability in a highly changing environment, quickly shifting focus as priorities change
• Presentation skills with ability to present to both peers, leadership, executives and external stakeholders such as vendors
• Exhibits creative problem solving skills, adapting approach as needed for each engagement
• Ability to effectively manage time and large workloads
• Ability to work independently at times with minimal intervention
• Effective organizational skills
• Ability to stay on task while working independently in a telecommute setting
• Ability to work effectively amongst direct peers to coordinate and support multiple work efforts