Collection Specialist - National Remote

You''ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. UnitedHealthcare is a company that''s on the rise. We''re expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn''t about another gadget, it''s about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life''s best work.SM This role will be responsible for ongoing management of market/reporting population specific quality measure medical record collection. The Collection Specialist will work in partnership with the market-level quality director to strategically increase HEDIS®, CMS STARs and state - specific measure performance scores by planning, performing, coordinating and monitoring medical record collection activities to meet or exceed quality standards, contractual requirements and pay for performance incentives. This role is dedicated to Quality and Value Solutions Delivery. Individual must be highly organized, possess strong leadership skills, with demonstrated professional maturity and emotional resilience. Day to day work varies based on time of year, with overarching goal to increase collection of member compliant information resulting in improved HEDIS® or other quality program rates. The core work during medical record collection includes oversight and completion of medical record collection, collaboration with vendors and vendor management as well as line of business representatives or leaders, consultation and cross - collaboration with market quality staff and executives, coordination of contract staff, building and maintaining provider group relationships, understanding and detailed documentation of provider group relationships and medical record collection requirements, as well as mining and reviewing data for project quality assurance. The role requires utilization of multiple claims systems, medical record collection tracking tools, electronic medical record systems, secure FTP, external lab portals, and immunization registries. This position is full - time. Employees are required to work our normal business hours of 8:00 AM - 5:00 PM. Training will be conducted virtually from your home. *All Telecommuters will be required to adhere to UnitedHealth Group''s Telecommuter Policy. Primary Responsibilities: Overall HEDIS® and other quality program knowledge Develops an understanding of HEDIS® including collection of RFI, ROADMAP and HOQ information as well as other project build activities, HEDIS® project timelines in order to improve HEDIS® scores, CMS Star Ratings and other metrics Responsible to understand and apply overall HEDIS® and quality knowledge to support and deliver HEDIS® / CMS measure proficiency at a market or reporting population level Completion of all required measure - level training to result in an in depth understanding of the technical specifications of all measures (both hybrid and administrative) to ensure adequate medical record collection Understanding of additional quality programs such as Risk adjustment and GRPro in order to effectively support medical record collection based on unique components of these projects Understanding of Prospective data collection activities Basic working understanding of billing and claims coding as well as medical record terminology Understanding of HEDIS® or other quality program project progress and results in order to prioritize collection to meet financial and timeline targets which requires the ability to be agile and shift priorities sometimes daily. Project Management Basic understanding of project management concepts such as project scope, project charters, stakeholders, timeliness, and project management tracking tools Ability to meet timelines associated to project tasks and/or diligence in expressing risks, issues and dependencies Building and maintaining professional relationships with providers and provider groups Builds trust and forms effective relationships with providers and provider group contacts by performing appropriate and professional outreach throughout the year and establishing agreed upon medical record collection requirements based on unique provider group preferences Research and outreach to understand provider group roll ups, i.e., ensuring collection is done at the most proficient level when provider groups have multiple locations and complex group structures Consistently maintain an accurate, detailed and up to date repository of provider relationships, medical record collection method details and accesss Medical Record Collection Planning, Management and Performance Attend and participate in weekly team meetings, biweekly team state pod meetings, weekly team huddles, and additional meetings as scheduled to ensure processes, strategies, priorities, tasks, etc are well understood and concerns, challenges or questions are addressed Develop an in depth understanding of multiple collection methods as well as the unique requirements and processes related to each; collection methods include EMR remote access, onsite, remote queued, fax, mail, secure email and external portal Coordinates and performs medical record collection using one of 7 collection methodologies to support HEDIS® activities or to investigate gaps in clinical documentation for performance improvement Employs a priority measure approach to HEDIS® data collection and gap closure Creates custom request lists based on identified provider group requirements during outreach Manages unique collection site requirements, and performing collection via alternate methods outside of the 7 methodologies as needed including through legal or network contract contacts Analyze data by running reports, sorting and formatting data via Excel, and utilizing vlookups, conditional formatting and other technical Excel skills in order to perform quality checks, data clean up, and further identification of medical record collection details In depth knowledge of and complete adherence to HIPAA guidelines in regards to handling PHI Create mailing labels and return mailing labels via UPS Campusship as needed based on group requirements; also may involve handling PHI according to HIPAA guidelines to route to local UPS store, if needed Perform medical record collection onsite at central provider group locations; requires travel planning, tracking expenses and submitting expense reimbursement requests, maintain strict standards of handling PHI according to HIPAA guidelines, and present professionally and ontime to onsite medical record collection appointments where records could be obtained via EMR, paper chart files and/or flash drive or CDs Contractor Management Participate in interviewing candidates, as requested by manager Assist with training via job shadowing, demonstration of tasks and systems, and performing quality checks to ensure they are job ready Assist with contactors gaining access to electronic medical records systems for remote access collection Work directly with contractor staff by delegating tasks and being available for review, questions, and support Participate in discussions regarding planning and strategy for hiring and use of contract staff as requested by manager Technical Skills Effectively and independently operate equipment such as laptop, multiple monitors, scanner, fax, and headset Utilize multiple systems including 7 different claims systems, medical record collection tracking tools and electronic medical record systems, secure FTP and lab portals, and immunization registries as well as our secure medical record chart repository, OnBase Utilize internal chase management tool, rateLIFT; participate in development workgroups, UAT and track issue log tickets as requested by manager Ability to perform key functions in rateLIFT in regard to updating provider demographics, multiple levels of provider group collection detail requirements, creating and scheduling requests, modifying requests, and creating, editing and manging provider groupings, etc. Strong Microsoft Office knowledge and skills in Outlook, Word, OneNote, MS Teams, and Excel, specifically performing functions such as vlookups, pivot tables, utilizing multiple filters, etc in Excel for data mining and organization purposes Knowledge of Adobe Acrobat and ability to combine, split and edit files as well as apply electronic signatures for agreement forms Ability to navigate multiple electronic medical record (EMR) systems in order to obtain relevant medical records according to quality program and / or HEDIS® measure specifications Collaboration with stakeholders, market quality departments and across roles within Quality Solutions Delivery Builds trust and forms effective relationships with stakeholders by providing timely operational updates, partnering on issue resolution/mitigation strategies, and monitors resolution of identified issues to conclusion Collaborate and consult with market quality leadership and other quality roles within UnitedHealth Group to ensure provider group relationships are utilized across roles in order to complete medical record collection in an organized, effective, timely manner as well as ensure provider abrasion from multiple outreaches doesn''t occur wherever possible. Participate in state market plan meetings, as needed, and evaluate concerns and present potential solutions in order to complete successful medical record collection and maintenance of provider relationships Improvement projects and Workgroup responsibilities Participate in and potentially lead improvement project and workgroups, as designated by leadership Present updates to peers on progress of workgroups You''ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: High School Diploma / GED (or higher) OR 2+ years of equivalent experience 4+ years of healthcare industry OR managed care experience 2+ years of direct HEDIS® and / OR medical record review experience Intermediate level of proficiency with Microsoft Word, Microsoft Excel, and Microsoft PowerPoint Ability to travel up to 25% of the time (Domestic) Ability to work any 8-hour shift between the hours of 8:00 AM - 5:00 PM Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation Preferred Qualifications: Associate''s Degree (or higher) Clinical and / OR Health Education experience, such as an RN OR LPN Experience in working with provider offices (clinician and non - clinicians) Knowledge of CMS STARs Experience with using Microsoft Visio and Microsoft SharePoint Project management experience Application of continuous quality improvement concepts, such as Six Sigma OR PDSA Telecommuting Requirements: Required to have a dedicated work area established that is separated from other living areas and provides information privacy Ability to keep all company sensitive documents secure (if applicable) Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service Soft Skills: Strong, professional, and effective interpersonal and communication skills, both written and verbal Energy, motivation, and commitment to drive to results in a challenging, fast - paced environment Diplomatic with strong negotiation and conflict resolution skills Demonstrated ability to meet commitments, build consensus, negotiate resolutions, and garner respect from other teams Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets / goals Demonstrates adaptability in a highly changing environment, quickly shifting focus as priorities change Presentation skills with ability to present to both peers, leadership, executives and external stakeholders such as vendors Exhibits creative problem solving skills, adapting approach as needed for each engagement Ability to effectively manage time and large workloads Ability to work independently, at times with minimal intervention Effective organizational skills Ability to stay on task while working independently in a telecommute setting Ability to work effectively amongst direct peers to coordinate and support multiple work efforts UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status. Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. Careers with UnitedHealthcare. Let''s talk about opportunity. Start with a Fortune 5 organization that''s serving more than 85 million people already and building the industry''s singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near - obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, Military families and Veterans wherever they''re found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that''s second to none. This is no small opportunity. It''s where you can do your life''s best work.SM Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $26.15 - $46.63. The salary range for Connecticut / Nevada residents is $28.85 - $51.30. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you''ll find a far-reaching choice of benefits and incentives Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. RPO, YELLOW

Created: 2025-11-15