JOB SUMMARY: Responsible for payor contract services and implementation of incentive programs.
DUTIES & RESPONSIBILITIES:
- Reviews and coordinates incentive programs offered by insurance payers with the Director of Contracting. Works with insurance payers to learn incentive programs. On site education of staff and resolution of issues.
- Outlines incentive program and requirements for implementation.
- Creates policies and procedures for staff for educational purposes.
- Implements incentive program and follows up to ensure requirements are being met and incentives are paid.
- Works with ITS to develop queries to validate incentive payments.
- Reviews progress issues of concern with Director of Contracting or Chief Executive Officer.
- Gives physician and staff feedback progress of the incentive program.
- Implements any necessary changes for improvement of the incentive program.
- Works to achieve optimal performance within value and risk based payment programs by supporting staff in the development and implementation of activities to close health care gaps and achieve quality goals.
- Reviews and coordinates population health/quality improvement programs offered by insurance payers. Works with insurances payers to learn these programs. On-site education of staff and resolution of issues.
- Outlines programs and requirements for implementation.
- Creates policies and procedures for staff for education purposes.
- Verifies health data within EPIC for assigned population to ensure ease of utilization of Health maintenance for providers.
- Implements programs and follows-up to ensure requirements are being met and incentives are being paid.
- Implements any necessary changes for improvement of the population health programs.
- On a yearly basis provides detailed breakdown of quality performance achievements and incentives received from insurance payers as well as formulates improvements for the next year.
- Acts as care manager for a limited roster of high risk patients in risk-based shared savings arrangements.
- May be exposed to hazardous drugs.
RELATIONSHIP WITH OTHERS: Direct relationship with clinical, reception, data entry and Business Office staff. Contact with physicians as well as patients.
EDUCATION/EXPERIENCE/KNOWLEDGE: Bachelors’ degree and clinical experience. Strong communication and organizational skills. Minimum of two years experience with insurance billing or follow-up. ICD 10, CPT, Excel/Microsoft knowledge a must.
PHYSICAL REQUIREMENTS: Requires sitting, standing bending and reaching. May require lifting up to 20 pounds. Requires manual dexterity sufficient to operate standard office equipment such as computer, fax, calculators and telephone. Requires normal hearing and vision.