Job Description:
Summary:
The Risk Adjustment Project Coordinator supports the risk adjustment initiatives for Excellus Health Plan.
Essential Primary Responsibilities/Accountabilities:
Level I:
Review, monitor and track the medical record retrieval reports to identify provider issues such as but not limited to, refusals to comply with medical record requests.
Initiate outbound phone calls to noncompliant providers to resolve provider refusal and/or concerns related to the Health Plan’s request for medical records.
Builds and maintains strong working relationship with providers and office staff.
Educate providers of their contractual obligation to comply with Health Plan’s request in a professional manner to minimize provider abrasion.
Directly negotiates with providers to procure scheduled commitment to deliver requested medical records, retrieval method, and payable fees for the medical records.
Identify and escalate program related issues to the Project Manager and/or Manager as appropriate.
Identify patterns generated by external and internal action effecting provider adherence as it relates to medical record requests.
Communicates issues/findings to the Project Manager and appropriate team members.
Responsible for collecting and scanning project related documents and disbursing to the appropriate audience.
Analyze, compile, and prepare retrieved medical records for transfer.
Initiate Health Plan check requests for provider payments.
Collaborate with various stakeholders to resolve provider issues to relative to medical record retrieval activities.
Fosters an environment of continuous improvement and encourages innovative thinking.
Constantly exploring ways to increase efficiencies and productivity, reducing waste, and reducing costs.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.
Level II (in addition to Level I essential responsibilities/accountabilities):
Manage the respective risk adjustment failed quality assurance (QA) medical records reports through research and analysis to include but not limited to, review/verify medical record failed according to QA guidelines, triage 2nd level review of as needed, identify problematic trends, prepare summary of trends for review and discussion.
Monitors and reports on the progress of the resolution of high impact problems according to established standards.
Identify opportunities through trend analysis for improvement including but not limited to, non-compliant providers, medical recording targeting anomalies, vendor retrieval processes.
Serve as designated liaison between special handle provider that include, large provider groups and hospitals.
Initiate communication with special handle providers of upcoming medical record requests campaign.
Directly negotiate with special handle providers to procure schedule commitment, payments, etc.
Initiate requests for customized reports for special handle providers and deliver to the requestor.
Performs daily data import to the Provider Issue Tracking database, assign provider escalation work items to the Project Coordinators, etc.
Acts as a resource for team questions.
Monitors and executes reports on provider escalation open inventory.
Serve as the liaison and facilitator for member related requests and/or inquiries relative to the prospective risk adjustment programs. Will triage and track issues through resolution.
Level III (in addition to Level II essential responsibilities/accountabilities):
Performs project management duties over small-tier risk adjustment or other initiatives as assigned.
Drives medical record retrieval activities in support of risk adjustment programs.
Works closely with Project Manager providing vendor oversight.
Assist Project Manager to determine project schedules, deliverables, assignments, tasks, project meetings (scheduling and meeting notes), status reporting, communication, and action items, as required.
Assist Project Managers and project teams to track work, tasks, and project assignments in order to keep projects on-time and within scope.
Serve as backup for Project Manager as needed.
Minimum Qualifications:
NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.
All Levels:
Associate degree in Business Administration or related field required. In lieu of degree, High School Diploma and three years related work experience required.
One year of related work experience required.
Demonstrates ability to operate within shifting priorities, demands and timelines.
Persuasive, encouraging, and motivating.
Strong all-around soft skills and high level of proficiency using written and oral communication skills
Demonstrated problem solving skills.
Strong organizational skills and ability to prioritize, multi-task, and work in a fast pace environment
Demonstrates technical proficiency in the following applications: MS Teams, Outlook, Word, OneNote and Excel.
Knowledge of claims, provider, and membership systems
Demonstrates ability to work effectively as a member of a team
Level II (in addition to Level I minimum qualifications):
Four years related work experience is required.
A relevant bachelor’s degree is preferred.
Self-motivated; ability to take initiative and ownership.
Interfaces effectively with all levels of management.
Demonstrated analytical and business process development skills.
In-depth knowledge of Health Plan Operations and/or Risk Adjustment Operations.
Ability to maintain poise and composure under pressure and in difficult situations.
Level III (in addition to Level II minimum qualifications):
Six years of related work experience is required.
Strong meeting facilitation skills
Ability to create, and manage project plans and schedule
Experience in drafting both internal and external communications to convey project findings and status.
Adept at conducting research when project-related issues occur
Expert knowledge of Health Plan Operations and/or Risk Adjustment Operations
Experience drafting concise and informative communication pieces at the department and/or project team level.
Physical Requirements:
Works from a desk most of the time.
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In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
Compensation Range(s):
Level I: Grade N5: Minimum $20.02 - Maximum $33.03
Level II: Grade N6: Minimum $21.83 - Maximum $34.92
Level III: Grade N7: Minimum $23.56 - Maximum $37.70
The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.
Please note: The opportunity for remote work may be possible for all jobs posted by the Univera Healthcare Talent Acquisition team. This decision is made on a case-by-case basis.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.