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Value-Based Care Coordinator - Hybrid - Erie

Highmark Health

Erie PA, 4247 West Ridge Rdvia Highmark Health

Company :

Allegheny Health Network

Job Description : 

GENERAL OVERVIEW:

This position works collaboratively with the Clinically Integrated Network and across the continuum of care to support success in value-based reimbursement (VBR) programs and department operations. Submits documentation to payers for VBR programs. Coordinates projects related to achieving departmental goals. Assists department leadership with day to day operations and execution of strategies to optimize performance in value-based programs.


ESSENTIAL RESPONSIBILITIES

  • Proactively provide quality chart review and direct submission to payer portals for gap closure. (40%)
  • Participate in the development of presentations and instructional materials to optimize VBR performance including Performance Summaries for Field Team and Executive Leaders, Practice Resource Binders, Medicare Shared Savings Plan (MSSP) submission tool kit. (20%)
  • Directly responsible for development and management of value team monthly Practice Reporting templates. (10%)
  • Assists in the development and implementation of strategies that support value based contract requirements and Clinically Integrated Network (CIN) goals. (10%)
  • Assists in the development and implementation of population health management strategies including telephonic outreach to patients for gap closure and care coordination. (10%)
  • Support VBR related initiatives across the continuum of care. (10%)
  • Other duties as assigned or requested. 


QUALIFICATIONS:

Required

  • Associates degree or relevant experience and/or education as determined by the company in lieu of Associates degree.
  • 1 year of experience in a health care delivery setting, preferable in a clinical role such as a medical assistant.
  • 1 year of experience with VBR programs and payer submission process.
  • 1 year experience of working independently with minimal supervision and meet project and payer deadlines.
  • 1 year of experience with Microsoft Office software (Word, Excel, Access, PowerPoint, etc.) 

  Preferred

  • Certified Medical Assistant (CMA) or Licensed Practical Nurse (LPN)
  • 1 year experience with an good understanding of various EMR systems.
  • 1 year of experience with VBR programs and payer submission process.
  • 1 year of experience with HEDIS/STARs metric specification and documentation requirements.
  • 1 year of experience managing large-scale projects preferably in the areas of quality, transformation and CINs.

SKILLS:

  • None

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.


As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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