This position will be responsible for managing all facets of provider contact by acting as mediator between vendors, providers and internal business partners regarding all revenue management projects such as Provider Collaborative Initiative, Epass, Home Assessment Program, Retrospective Chart Reviews and our SSC program. Functions shall include, but not be limited to provider outreach and education regarding medical record compliance and access, departmental communications, vendor audit coordination and general reporting.
In order of significance, list up to 6-8 of the main tasks performed regularly to fulfill the basic function of the job. Each accountability should begin with an action verb (e.g., design, manage, implement, develop, evaluate, administer, and coordinate). % of Time
• Manage all facets of provider contact by acting as mediator between vendors, providers and internal business partners regarding all revenue management projects including working with providers and vendors directly to gain access to medical records for Medicare & Medicaid members. This position will audit that chase lists provided for accuracy and completeness, then work with the sites directly to schedule visits while minimizing provider abrasion. Will work the issue log timely and be responsible for escalating provider issues to appropriate internal/external contacts. 40
• Ensure that all Epass cycles kicks off timely and that all providers are properly trained regarding the Epass system and CMS/SDOH compliance for HRA’s, system technical support, rolling out new provider implementations, ensuring accurate reporting and provider’s general inquiries. Will also ensure that end of cycle analytics are performed and providers are paid timely. 30
• Maintain a tracking system that records all outreach activity, including updating incentive payments owed to providers for PCI and all chart request activities and effectively communicate all concerns both internally & externally. 15
• Coordinate all provider education and compliance as well as provider and member communications for all departmental programs. This includes coordinating with our Quality & Stars team leaders or their designees. 15
• Regular attendance is an essential function of the job. Performs other duties as assigned or required.
Position Success Criteria
List the actions, skills and knowledge required to perform the job successfully
• Ability to translate data into action plans or specific goals
• Ability to listen and communicate based on audience’s perspective
• Ability to build successful working relationships both internally and externally
• Ability to effectively manage multiple high priority and high profile tasks for multiple providers
• Strong decision-making and problem-solving capabilities
Education and Experience
List the required and preferred specialized education and/or scope of related experience required to successfully achieve the principal accountabilities of the position. Include job related experience, specialized training, certification or any special licensing necessary.
• Bachelor’s Degree in Healthcare, Finance or Business preferred; Master’s Degree, a plus but not required
• Minimum three to five years’ experience, preferably in Healthcare , plan or provider operations and relations; other related experience may also be considered
• Excellent organizational, project management, and relationship management skills
• Excellent oral and written communications skills
• Strong customer service phone experience
• Capacity to Multitask at high detail oriented level
• Strong working knowledge of MS office applications, specifically Excel, Access knowledge a plus
Internal Job Posting Expires: 2/21/13
EmblemHealth - 23 months ago
EmblemHealth is set on being the mark of good health in the Northeast. The not-for-profit company provides health...