Erin Godschalk

• Stayed up-to-date on industry trends and best practices, incorporating relevant information into reviews as needed.
• Monitor industry trends to adapt review criteria, maintaining competitive edge in content evaluation processes.
• Reviewed medical records to ensure they meet NCQA and CMS guidelines

• Assists with the Population Health team's administrative, operational, and program activities including: initiating, monitoring and tracking internal department activities and practices activities

• Develop, implement and maintain population level outreach initiatives to close gaps in patient care and/or improve the care of identified disease populations

• Assist in managing professional relationships with ICP contracted payors, providers/practices, and vendors. • Assists in the development and delivery of quality and risk related education, communication, and practice-level engagement efforts to achieve established quality, utilization and cost goals

• Participate in Health Information data review and research to satisfy HEDIS records standards and HEDIS measure criteria.

• Performs other duties as assigned.

• Develop and maintain strong relations with our PCP’s and Specialty groups

• Host monthly meetings to deliver relative information

• Provider trainings via in person or online

• Respond to electronic and direct inquiries from providers about policies, rates, changes, referrals, eligibility, credentialing, ect.

• Communicates with internal departments, external companies and data sources as needed for data aggregation activities

• Knowledge of quality, HEDIS, STARS, Medicaid, and Medicare

• Familiar with claims and contracts

• Audit HEDIS provider data
• Assisted in developing recommendations for quality improvement activities for our providers
• Assist with creating training/marketing materials
• Schedule and visit physician practices to implement HEDIS
• Perform duties and functions to comply with quality improvement programs according to state requirements
• Assist physician practices to identify opportunities to optimize HEDIS encounter data
• Assists management in implementing key quality strategies
• Work closely with health plans on provider interventions, data collection and other quality-related projects
• Communicates with internal departments, external companies and data sources as needed for data aggregation activities
• Work with internal programs to run reports, summarize performance data, identify opportunities and relate information effectively to providers and management
• Assists with HEDIS data evaluation and reporting to affiliated entities
• Knowledge with Athena, IMS/MediTab, and NextGen

• Room patients, take vitals
• Injections, tray set up, rapid strep tests, ECG's
• Communicate with patients on behalf of the Doctors
• Complete and schedule referrals

• Chase / Request / Track medical records
• Verify that the members were in compliance with the HEDIS program
• Audit medical records and monitor performance measures for HEDIS
• Meet strict deadlines