Remote HEDIS & Risk Retrieval Subject Matter Expert (SME)

We are seeking a highly skilled and experienced HEDIS & Risk Retrieval Subject Matter Expert (SME) to join our team at Optum. As a SME, you will play a critical role in providing expertise in medical record retrieval and managing client relationships, supporting our Retrieval Operations department in driving operational excellence and enhancing retrieval processes. This remote opportunity offers flexibility and the chance to address challenges in health data retrieval and client management.

Key Responsibilities

• Develop and coordinate ad-hoc reporting for retrieval as needed, identifying opportunities to improve operating efficiencies and effectiveness
• Assist in the development of user guides, standard operating procedures, job aids, and presentations for training, ensuring seamless knowledge transfer
• Provide consultative support and strategy to clients, assisting them in achieving business goals and resolving issues in a timely and professional manner
• Manage client retrieval issues, partnering with Quality Program Managers (QPMs) and the Customer Success Team to drive client quality and production concerns
• Lead issue resolution with vendors on system or reporting issues, identifying risks and developing remediation plans as needed
• Develop and monitor vendor system retrieval enhancement requirements, ensuring alignment with changing operations and business needs
• Utilize problem-solving skills, meeting deadlines, and working independently to drive efficiencies and motivate others

Requirements

• 2+ years of experience in HEDIS and/or Risk chart retrieval, with a deep understanding of medical record contents and health data retrieval processes
• 2+ years of experience working for a health plan and/or a provider's office, with a strong background in client management and relationship-building
• Experience creating and presenting slide decks, with proficiency in MS Word, PowerPoint, and Excel (including pivot tables and v-lookups)

Nice-to-Haves

• 2+ years of experience in managing individual and group projects, with a proven track record of success in driving project outcomes
• 2+ years of experience analyzing provider and claims data, with a strong understanding of data analysis and interpretation
• Working knowledge of general medical record contents, with proficiency in MS Access (intermediate+)

What We Offer

• 401(k) matching, with a competitive benefits package
• Health insurance, with a range of options to suit your needs

If you are a motivated and experienced professional looking for a challenging and rewarding role, please apply now or apply to this job to join our team as a Remote HEDIS & Risk Retrieval Subject Matter Expert (SME).

Alternatively, you can apply to this job directly.