Stars Network Performance Specialist - Miami-Dade County

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Clinical Quality Analyst (Stars Network Performance Specialist) works to improve quality and recommend process improvements. The Stars Network Performance Specialist assists the Stars Network Performance Team, Revenue Cycle Management (RCM) team and the Network Management Services (NMS) team in support of comprehensive business operations to increase Star rating goals. Primary duties include physician Stars education and acting as a liaison between Plan and provider as it relates to Stars. Under general direction, the Stars Network Performance Specialist is responsible for assisting in the daily operations of the Stars Network Department with all duties including, but not limited to, the responsibilities outlined below. This role will require daily travel to providers' offices in Broward and Miami/Dade counties.

This position will work in-office, and the incumbent will report to the Miami-Dade office when not traveling in the field. There is approximately 90% travel in Miami-Dade County.

Primary Responsibilities:

• Perform group and individual training session according to the CMS Stars technical specs
• Analyze provider Stars Non-Compliant List, Scorecards and other Stars reports to identify areas with opportunity
• Accountable for the process of the provider to reach Star rating goals
• Accountable for meeting monthly provider visit goal
• Liaison between provider and health plan to achieve provider, group and plan rating
• Share/educate provider on HEDIS tools and resources
• Review/recommend provider STARS/HEDIS coding practices for optimal outcomes
• Analyze work processes and identify areas where procedures and quality could be improved
• Audits medical records to assure proper coding of submitted claims, and analyze provider gaps
• Educates providers on proper documentation & coding for HEDIS compliance
• Works closely with other departments (Finance, Network Management Services and Revenue Cycle Management) on provider progress/challenges
• Flexibility in performance of work assigned in order to meet goals

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:

• 2+ years of experience developing and implementing performance improvement projects or using data to develop intervention strategies to improve outcomes
• 2+ years of managed care experience
• Experience related to quality improvement / performance outcomes such as: HEDIS, STARS, NCQA and CAHPS/HOS
• Intermediate experience with MS Office including Word, Excel, Outlook, and PowerPoint
• Intermediate level skills interpreting data and making process improvement recommendations after data analysis
• Ability to collect, analyze and present data
• Excellent verbal and written communication skills
• Lives in Miami-Dade County
• Reliable transportation and the ability to travel within Miami-Dade County to meet with providers

Preferred Qualifications:

• Prior experience in large, multi-function and cross geographic organizations
• Bilingual (English and Spanish) strongly preferred
• Coding and medical record abstraction experience strongly preferred
• Solid organizational skills and ability to work both independently and with teams
• Ability to evaluate medical records with attention to detail
• Ability to use databases and prepare reports as needed
• Ability to organize and coordinate group meetings

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.