The Role
Perform chart reviews and patient outreach to close HEDIS care gaps, document in EMR, manage medical record retrieval and uploads, lead quality improvement projects using DMAIC, train staff, create HEDIS/medication adherence visualizations, and report team data to leadership.
Summary Generated by Built In
Under limited supervision, responsible for performing a variety of clinical support functions for the outpatient setting including patient outreach, care gap analyses, and patient follow up.
Responsibilities
Benefits Overview
- Performs patient chart reviews to identify opportunities in patient care to satisfy HEDIS measure gaps.
- Maintains systems for storing and tracking HEDIS medical record documentation
- Documents in the Electronic Medical Record.
- Outreaches and requests charts and medical records from other facilities to close gaps in care
- Scans or uploads medical records into payor databases
- Performs patient outreach to schedule Annual Welllness Visits and Follow up appointments to fill gaps in care
- Performs pre-visit evaluations that identify gaps in care for the clinical team and post-visit evaluations that identify gaps in care after the visit.
- Educates staff in the clinics about the metrics and how to close HEDIS gaps in care.
- Identifies, tracks, and follows up on gaps in care that cannot be or were not closed in the clinic.
- Performs medication adherence reviews to identify and mitigate barriers to patients not taking their medication.
- Assists in processing hierarchical condition category attestation forms from payors.
- Identifies opportunities for and works with Senior QISs to implement projects for continuous quality improvement.
- Using evidence-based principles of change management (e.g. DMAIC and other Quality tools) implements projects and processes to improve workflows, processes, and procedures.
- Is responsible for creating and publishing workflows for processes for team to follow
- Is responsible for organizing and maintaining internal files and folders up to date
- Provides in-service training and precepting to Associate Level QI specialists.
- Creates data visualization for HEDIS metrics and medication adherence
- Is responsible for reporting team data at leadership meetings
- Meets with payors representatives to identify and discuss strategies for gap closures
- Leads quality improvement projects, including root cause analyses, related to quality metrics to focus efforts to positively influence results.
- Performs all other duties as assigned.
- Demonstrates the ability to support the mission, vision and patient promise throughout all interactions, The UT Health Way.
- Demonstrate the ability to communicate effectively, written and verbally.
- Demonstrates analytical thinking – this role requires analyzing information and using logic to coordinate work within schedule constraints and handle emergent requirements in a timely manner
- Demonstrates the ability to participate as an integral part of the interdisciplinary healthcare team in providing the highest quality of care to the patient, The UT Health Way.
- Working knowledge of HEDIS measures for which UT Health is responsible under the shared savings programs
EDUCATION:
HS Diploma or GED
About Us The University of Texas at San Antonio (UT San Antonio) is a nationally recognized, top-tier public research university that unites the power of higher education, biomedical discovery and healthcare within one visionary institution. As the third-largest research university in Texas and a Carnegie R1-designated institution, UT San Antonio is a model of access and excellence — advancing knowledge, social mobility and public health across South Texas and beyond. UT San Antonio serves approximately 42,000 students in 320 academic programs spanning science, engineering, medicine, health, liberal arts, AI, cybersecurity, business, education and more. With 17,000 faculty and staff, UT San Antonio has been recognized by Forbes as one of America’s Best Employers for Company Culture.
Benefits Overview
UT Health San Antonio offers an excellent benefits package for its employees. Employees who work at least 20 hours a week, with an appointment of at least 4.5 months, are eligible for benefits.
Medical - UT SELECT Medical insurance is offered free for employees and administered by Blue Cross and Blue Shield of Texas. Family members can be added to the plan through payroll deduction. Employees and their dependents can also receive discounted copays and coinsurance when using UT Health Physicians, a network of 800 premier physicians including more than 100 specialists. Employees receive $50,000 of group term life insurance and $50,000 of basic accidental death and dismemberment insurance for free, with options to purchase additional employee and dependent coverage for both at group rates.
Dental - Three dental insurance plan options are available for employees and their families through Delta Dental Insurance Company, two PPOs and one dental HMO plan. Both PPO plans allow employees to choose any licensed dentist.
Vision - Fully insured Vision Care benefits are offered by Superior Vision Services. Two vision plan options that offer either standard or enhanced vision benefits.
Disability - Employees can enroll in the Disability Insurance which provides income if a non-work related illness or injury prevents you from working.
FSAs - Employees can enroll in flexible spending accounts (FSAs) to set aside money from earnings before taxes for qualifying dependent day care expenses or out-of-pocket health care expenses.
Retirement - Employees are eligible for either the Teacher Retirement System (TRS) or the Optional Retirement Plan (ORP). TRS is a defined benefit retirement plan which UT Health matches employee contributions. ORP is for eligible faculty staff employees. Voluntary retirement programs are also available to invest before- or after-tax dollars with the choice of five quality retirement plan providers.
Time Off - A generous leave program offers multiple paid leave options:
- Front-loaded Paid Time Off: 128 to 208 hours (16 to 26 days) of Paid Time Off based on years of service, given at the start of each fiscal year. PTO may be prorated in year one based on date of hire.
- Extended Illness Bank: 8 hours (1 day) accrued per month which can be used for illness or injury after one day of Paid Time Off is taken.
- Paid Family Leave: Up to 240 hours (6 weeks) to care for a spouse, child, or parent after 6 months of consecutive employment.
- Holidays: 12 set paid holidays each year.
Discounts - Employees enjoy a range of discounts on services, tickets, and gym membership.
EEO Statement
UT Health San Antonio is an equal employment opportunity and affirmative action employer. It is our policy to promote and ensure equal employment opportunity for all individuals without regard to race, color, religion, sex, gender identity, national origin, age, sexual orientation, disability, or veteran status.
Skills Required
- High school diploma or GED
- Working knowledge of HEDIS measures and gap-closure processes
- Experience documenting in an Electronic Medical Record (EMR)
- Experience performing patient outreach and scheduling for preventive care
- Experience scanning/uploading medical records into payor databases and managing records
- Experience with quality improvement methodologies (e.g., DMAIC) and implementing projects
- Ability to create data visualizations for HEDIS metrics and medication adherence
- Strong written and verbal communication skills and ability to educate clinic staff
- Analytical thinking and ability to perform chart reviews and root cause analyses
Am I A Good Fit?
Get Personalized Job Insights.
Our AI-powered fit analysis compares your resume with a job listing so you know if your skills & experience align.
Success! Refresh the page to see how your skills align with this role.
The Company
What We Do
UT Health San Antonio™, one of the country’s leading health sciences universities, is the leader in south/central Texas funding for the National Institutes of Health (NIH). The university’s schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have produced more than 33,000 alumni. The $806.6 million operating budget supports four campuses in San Antonio and Laredo, and is the primary driver of its community’s $37 billion biomedical and health care industry. For more information on the many ways “We make lives better®,” visit uthealthsa.org.
%20copy.jpg)
