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Outreach Coordinator, HEDIS

Primary Location: San Antonio, Texas
Additional Locations: TX-San Antonio

The HEDIS Outreach Coordinator facilitatesProviders and Members outreach to ensure receipt of important clinical servicesto improvement member's health outcomes. This position also provides supportfor Healthcare Effectiveness Data and Information Set (HEDIS) qualityinitiatives and regulatory/contractual requirements including outreach tomembers who are noncompliant in the designated outreach services. Plus,supports effective medical record capture for HEDIS medical record review andabstraction of supplemental data.

Fundamental Components:

Identifies potential resources and initiates
collaboration with providers to improve member health outcomes and HEDIS
measures. Makes outbound calls to members to provide assistance in obtaining
services (i.e., provide reminders, make appointments, arrange transportation,
etc.) to avoid delays in treatment and improve member health outcomes.
Identifies when to refer member to Social Worker or Case Manager. Develops and
distributes educational information to members and providers in accordance with
the HEDIS outreach work plan (mailings, social media, automated calls, etc.)
Assists in the development and standardization of outreach documentation and
manages the data flow process to complete HEDIS documentation. Documents member
participation in outreach activities in accordance with abstraction and audit
standards. Conducts HEDIS provider chart request calls and mailings. May
develop and maintain member incentive programs to support HEDIS initiatives.
Maintains incentive database to track member compliance. May identify
opportunities to partner with community organizations on special events and
presentations (i.e., health fairs and community events). Works with internal
staff to schedule, organize, and staff these events. Records and documents all
member and provider outreach activity.

Background Experience:
Minimum of 3 years of Customer Service
experience within the managed health care industry.

Previous inbound and outbound call experience.

Proficient skill level with Microsoft Office Suite Programs: Word, Excel
and Outlook.

Show eagerness and passion for the work we do and able to work in a team

Recognize that this is an ever changing environment, good change management

Must be able to prioritize tasks, good time management skills.

Minimum 3 years' recent and related health care marketing, outreach and/or
health education experience.

Recent and or related experience working with HEDIS criteria Experience
working in call center environment Strong communication skills and experience
speaking with members and medical providers.

Ability to work independently. Ability to use standard corporate software
packages and corporate applications.

Required Skills:
General Business - Communicating for Impact, General Business - Consulting for Solutions, Service - Improving Constituent-Focused Processes

Desired Skills:
Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality

Functional Skills:
Clinical / Medical - Clinical claim review & coding, Customer Service - Call center monitoring & analysis - Inbound calls - call center location, Customer Service - Customer Service - Member Services - Traditional products

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Potential Telework Position:

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Click To Review Our Benefits (PDF)


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