COPE Health Solutions Careers

Description

• Conduct outbound calls to members to educate them on open care gaps (e.g., screenings, chronic condition monitoring, immunizations).
• Assist members with scheduling preventive and follow‑up appointments with their primary care provider or specialist.
• Provide reminders, instructions, and follow‑up support to ensure members complete recommended services.
• Document all outreach attempts, outcomes, and barriers in the appropriate systems.

• Contact provider offices to request medical records needed for HEDIS hybrid measures.
• Coordinate chart retrieval logistics, including fax requests, EMR access, secure email, and vendor retrieval scheduling.
• Track provider responses, escalate non‑responsive offices, and ensure timely completion of retrieval tasks.
• Maintain organized logs of outreach attempts, record status, and documentation received.

• Support the HEDIS Lead with chase list management, outreach prioritization, and data entry.
• Assist with basic chart review tasks such as confirming documentation presence, verifying dates of service, or flagging incomplete records (non‑clinical abstraction).
• Monitor daily progress toward retrieval and outreach targets and report barriers or delays.

• Provide clear, empathetic communication to members regarding preventive care, chronic condition management, and the importance of screenings.
• Identify and document member‑reported barriers to care (transportation, access issues, appointment availability) and escalate as appropriate.
• Support CAHPS‑related initiatives through member education and service navigation.

• Maintain accurate, audit‑ready documentation of all outreach activities, provider interactions, and record retrieval efforts.
• Assist with preparing materials for Stars workgroups, HEDIS meetings, and quality committees.
• Support the development of outreach scripts, workflows, and process improvements.

• Work closely with the HEDIS Lead, Quality Improvement Specialist, Care Management, Provider Relations, and vendor partners.
• Communicate provider issues, member barriers, and operational challenges to the HEDIS Lead for resolution.
• Participate in training sessions, huddles, and performance review meetings during HEDIS season. 

• High school diploma or equivalent; associate degree preferred.
• 1–2 years of experience in healthcare, customer service, call center operations, or medical office support.
• Strong communication skills and comfort speaking with members and provider staff.
• Basic understanding of preventive care, chronic conditions, and healthcare terminology.
• Proficiency with Microsoft Excel and ability to learn new systems quickly.
• Strong organizational skills and attention to detail.

• Experience in managed care, Medicare Advantage, or HEDIS operations.
• Prior experience with member outreach, appointment scheduling, or medical record retrieval.
• Familiarity with EMRs, chart retrieval platforms, or care‑gap reporting tools.
• Bilingual skills (Spanish, Mandarin, etc.) helpful but not required.

• Clear and empathetic communication
• Persistence and follow‑through
• Strong documentation discipline
• Ability to manage high‑volume outreach
• Comfort navigating provider offices and workflows
• Team‑oriented and adaptable
• Detail‑focused and process‑driven