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| Job Category : | Management |
| Company Name: | HealthSmart Management Services Organization, Inc. |
| Position Name: | Provider Member Outreach – Supervisor |
| Location : | 5785 Corporate Ave, Cypress, CA 90630 |
| Job Description : | POSITION SUMMARY: This position is responsible for projects, monthly/quarterly/annual reporting, and member/provider outreach and any additional support as needed. This position assists in the coordination of various projects and activities to include planning, organization, implementation, maintenance, and timely completion of interventions, data manipulation and management, project reporting, and status updates. The candidate must have experience in the Manage Care Industry with Medicare Advantage, Medi-Cal, and commercial health insurance knowledge and experience.This position reports to AVP of Provider Member Outreach.EDUCATION/EXPERIENCE REQUIREMENTS: BA or AA Degree preferred.2+ yrs. HMO/IPA experience preferred, knowledge of Medicare, Medicare Advantage, Medi-Cal and Managed Care experience is preferred.Satisfactory completion of a Medical Terminology course required.CPT and ICD-10 coding experience preferred.Risk adjustment and HEDIS quality experience preferred.Experience working in managed health care industry.Knowledge of managed care performance measures and quality improvement activities.General background knowledge of managed care delivery system.Data collection and project coordination experience desirable.Working knowledge software programs such as Microsoft Word, Excel, and Access.Excellent oral and written communication skills.Strong research, methodology, and analytical skills.Strong problem solving and organizational/time management skills with the ability to work in a fast paced environment.Ability to manage several tasks/projects simultaneously.Ability to work with multiple cross-functional project teams in order to meet project schedules, costs, and performance objectives.DUTIES/RESPONSIBILITIES: Distributes and explains in detail the Risk Adjustment and Quality improvement reports for HEDIS and Pay for performance to contracted providers.Distributes and explains in detail the missing encounter data and Medication Adherence reports to contracted providers.Assist in the Distribution of the Medi-Cal Retention Reports.Assists in downloading and preparation of assigned reports (monthly, quarterly, and annual) for presentation to various committees.Assists in downloading and preparation of Risk Adjustment reports from Optum Insight.Assists in the development of project plans, materials, and timelines for HEDIS, STAR, HCC, and CDPS Risk-Adjustment in accordance with regulatory mandates.Prepares project status updates and reports and convey information as appropriate to internal teams and staff.Assists in the development of outreach letters, scripts, and other materials as needed.Assist in checking the OIG and GSA websites monthly.Assist in Credentialing as needed.Collaborates with other departments regarding database and outreach management to effectively compile data for tracking and trending purposes.Assists other departments and coordinates other projects as directed by Manager.Cross-training to assist in department requirements and deadlinesEmbraces the team concept and shares areas of expertise with associates.Maintains ability to prioritize work and meet deadlines.Promotes professionalism of all employees, including phone etiquette, manners, appearance and attitude.Performs other related duties as assigned.Please submit salary requirements along with resume.Job Type: Full-timeBenefits:401(k)401(k) matchingDental insuranceFlexible spending accountHealth insuranceLife insurancePaid time offRetirement planVision insuranceSchedule:8 hour shiftMonday to FridaySupplemental Pay:Bonus payAbility to commute/relocate:Cypress, CA 90630: Reliably commute or planning to relocate before starting work (Required)Education:Associate (Required)Experience:HMO/IPA: 2 years (Required)Medicare, Medicare Advantage, Medi-Cal and Managed Care: 2 years (Required)CPT and ICD-10 Coding: 2 years (Required)Risk Adjustment and HEDIS: 2 years (Required)License/Certification:Driver’s License (Preferred)Work Location: One location |
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