Verification Specialist-LVN WellMed - San Antonio, TX - Full-time / Part-time

We are pleased to announce that we are hosting a Nurses Meet and Greet in Dallas, TX on September 8th at the DFW Airport Marriot from 4-8pm Central and want to formally invite you to join us! This informal event will give you the opportunity to speak with professionals from our organization about what it is like to be a part of the WellMed family, delivering concierge-level medical care and service for seniors. For registration and more information, please follow this link: uhg.hr/WellMedRNMandG2. We look forward to meeting you and learning more about your career motivations!
 
This position is responsible for the Primary Source Verification process and coordination of HEDIS and STARs data gathering process within the eCW and DataRaps applications. This evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records.
 
Primary Responsibilities:

Analyze data, evaluate for possible data integrity and data deficits and document findings
Over reads the data entry of non-standard supplemental data obtained from medical record review
Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures
Review of scanned records and data entry into DataRaps application
Support chart chase process by requesting records from provider's offices as needed
Supports and improves communications between market and corporate departments
Maintains education/knowledge base of HEDIS/STARs standards and guidelines
Performs all other related duties as assigned

Required Qualifications:

Licensed Vocational/Professional Nurse
Prior HEDIS/STAR experience or participation with similar regulatory reporting
Three or more years of healthcare experience to include experience in a managed care setting
Three or more years of experience with data analysis/quality chart reviews. Must be able to review data and provide recommendations for improvement
Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets
 
Preferred Qualifications:

Two or more years of college, in pursuance of a Bachelor's or Associate's degree
Two or more years of experience working with HEDIS/STAR measures
 
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 90,000+ 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
 
 
Diversity creates a healthier atmosphere: 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. Certain positions are subject to random drug testing.