Stars Network Performance Specialist - Miami/Dade & Broward Counties - Full-time / Part-time

The Stars Network Performance Specialist (SNPS) 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 SNPS 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.

Primary Responsibilities:

• Perform group and individual training session according to the CMS Stars technical specs and recommend documentation and coding practices to ensure CMS compliance, not limited to: Provider education; HEDIS specs; Coding on a specific measures; Analyze provider gaps; Liaison between provider and Stars Improvement Team to achieve individual, vendor and plan rating 


• Accountable for the process of the provider to reach Star rating goals 


• Accountable for meeting monthly provider visit goal 


• Liaison between provider and Stars improvement team to achieve individual, vendor and plan rating 


• Maintain an open line of communication with other departments, specifically NMS and RCM, on any progress/challenges 


• Share/educate provider on 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 


• Submits inaccurate codes to be removed or corrected 


• Provides proper documentation and Medicare risk adjustment education to physicians 


• Provides risk adjustment and correct coding training to billing staff/coders 


• Works closely with other company departments to assure risk adjustment and coding compliance 


• Flexibility in performance of work assigned in order to meet goals
  

Required Qualifications:

• High school diploma or higher level of education 


• 1+ years related coding experience and/or training 


• Bilingual skills - fluency in Spanish/English 


• Proficient level of experience in Microsoft Office applications such as Word, Excel, and Outlook 


• Strong organization and time management skills, with the ability to work independently 


• Strong verbal and written communication skills 


• Familiarity with Broward and Miami/Dade counties, with a reliable vehicle and the ability to travel daily within this service delivery area

Additional Preferred Assets:

• Certified Professional Coder or Certified Coding Specialist 


• Previous medical record review experience 


• Experience working with HEDIS measures 


• Knowledge of Medicare/Medicaid guidelines and regulations
  

Careers at UnitedHealthcare Medicare & Retirement.

The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work. (sm)

Keywords: coding, CPC, CCS, coder, HEDIS, CMS, Stars, analyst, quality, provider, compliance, Medicare, FL, Miami, Dade, Broward