Patient Engagement Specialist I

Department: Quality - Quality Care Improvement

Employment Type: Full Time

Location: 600 City Parkway West 10th Floor, Orange, CA 92868

Reporting To: Celine Phan

Compensation: $20.00 - $25.00 / hour

Description

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence 
• Be Innovative
• Work As One Team

What You'll Do

• Conduct outreach calls to inform patients of recommended services for HEDIS measure gap closure in a courteous and engaging manner
• Requests and gathers necessary medical records as needed.
• Effectively organize projects and tasks based on priority to help meet expectations and deadlines of projects
• Collaborates with the health plan, PCP, and health care team to ensure timely communication of member's clinical information.
• Generates letters and faxes to PCPs, Specialists, patients, and other health care team members.
• Analytical problem solving with the ability to understand the overall picture
• Coordinate care for patients as appropriate such as scheduling appointments, creating authorizations to facilitate/expedite patient’s requests based on provider’s orders.
• Maintain strict confidentiality of business discussions
• Travel to various offices as designated
• Ad-hoc projects as assigned by the manager/supervisor
• May be required to work overtime to meet tight deadlines
• Comply with department policy and procedures
• Collect and collate appropriate data from IPA network providers for HEDIS measures
• Collect medical records, conduct reviews and ensure accuracy of documentation for reporting
• Collect, summarize and trend provider performance data to include provider education
• Participate in ongoing discussions concerning data collections and analysis for HEDIS
• Assist in planning and implementation of projects to improve delivery of services and quality of care
• Understand the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards and HIPAA
• Generate and maintain accurate weekly/monthly/quarterly report of activities
• Attend to health plans, provider, and interdepartmental calls

Qualifications

• Minimum of Associate's degree, Bachelor’s degree or equivalent years of experience
• Experience using Microsoft applications such as Word, Excel and Outlook 
• Proficiency in electronic scheduling
• At least one (1) year of HEDIS related experience
• Must have Driver’s License, reliable transportation and be willing to travel between office locations as needed
• Ability to prioritize and effectively multi-task
• Ability to quickly adapt to various situations
• Excellent organizational skills and strong attention to detail
• Effective and professional communication skills
• Self-driven, quick learner, patient, must be able to work with people of different personalities

• Fluent in Spanish and/or Chinese (Cantonese/Mandarin)
• 1-3 years of IPA/MSO/HP or general healthcare experience
• Excellent analytical critical reasoning and interpersonal communication skill
• Ability to work in a fast-paced environment
• Ability to keep a high level of confidence and discretion when dealing with sensitive matters relating to providers, members, business plans, strategies and other sensitive information

Environmental Job Requirements and Working Conditions

• Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The home office of this department is located at 600 City Parkway West, 10th Floor, Orange, CA 92868.
• The total compensation target pay range for this role is $20.00 - $25.00 per hour. The salary range represents our national target range for this role. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.