HEDIS & Risk Retrieval SME - Remote

About the position The HEDIS & Risk Retrieval Subject Matter Expert (SME) role at Optum involves providing expertise in the retrieval of medical records and managing client relationships. This position supports the Retrieval Operations department by coordinating operational tasks, developing reports, and enhancing retrieval processes. The role is remote, allowing flexibility while addressing challenges in health data retrieval and client management.

Responsibilities

• Coordinate and develop adhoc reporting for retrieval as needed

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• Seek opportunities to improve operating efficiencies/effectiveness

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• Assist in development of user guides, standard operating procedures, job aids and presentations for training

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• Assist with issue escalation as needed

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• Maintain tracking of key retrieval facts and dates by client

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• Manage client retrieval issues for assigned clients in partnership with Quality Program Managers (QPMs) and Customer Success Team

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• Provide system and process training

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• Provide consultative support and strategy to assist clients in achieving business goals

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• Attend weekly meetings with clients to present retrieval performance and metrics

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• Partner with QPMs and Customer Success Team to focus on client quality and production concerns

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• Review production reports to identify risk to meeting business objectives and compliance with client SLAs

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• Lead issue resolution with vendor on system or reporting issues for Retrieval

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• Partner with vendor in identifying risks to meeting business objectives and developing remediation as appropriate

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• Lead in identifying, developing & communicating retrieval application enhancements and system performance

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• Coordinate file specification requirements between Optum and vendor

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• Improve existing retrieval application reports to better align with changing operations and business needs

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• Develop and monitor vendor system retrieval enhancement requirements from QPMs

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• Develop test cases used for vendor application testing

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• Oversee file management transfer from Optum, client and vendor regarding Retrieval and resolve issues as needed

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• Participate in assisting UAT team in Optum product testing, including development and testing of test case scenarios

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• Utilize skills in problem solving, meeting deadlines, working independently, and motivating others to drive efficiencies.

Requirements

• 2+ years of experience in HEDIS and/or Risk chart retrieval

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• 2+ years of experience working for a health plan and/or a provider's office

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• Experience creating and presenting slide decks

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• Proficiency with MS Word (intermediate+)

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• Proficiency with PowerPoint (intermediate+)

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• Proficiency with MS Excel, including pivot tables and v-lookups

Nice-to-haves

• 2+ years of experience in managing individual and group projects

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• 2+ years of experience analyzing provider and claims data

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• Working knowledge of general medical record contents

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• Proficiency with MS Access (intermediate+)

Benefits

• 401(k) matching

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• Health insurance

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