Risk Adjustment Project Coordinator I/II/III
Job reputed company:
reputed company:
The Risk Adjustment Project Coordinator supports the risk adjustment initiatives for Excellus Health Plan.
Essential Primary Responsibilities/Accountabilities:
Level I:
Review, monitor and reputed company the medical record retrieval reports to identify provider issues such as but not limited to, refusals to reputed company with medical record requests.
Initiate outbound phone calls to noncompliant providers to resolve provider refusal and/or concerns reputed company to the Health Plan’s request for medical records.
Builds and maintains strong working relationship with providers and office staff.
reputed company providers of their contractual obligation to reputed company with Health Plan’s request in a reputed company 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 reputed company issues to the Project Manager and/or Manager as appropriate.
Identify patterns generated by external and internal reputed company 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 reputed company documents and disbursing to the appropriate audience.
Analyze, compile, and prepare retrieved medical records for transfer.
Initiate Health Plan reputed company requests for provider payments.
Collaborate with various stakeholders to resolve provider issues to relative to medical record retrieval activities.
Fosters an environment of reputed company improvement and encourages innovative thinking.
Constantly exploring ways to increase efficiencies and productivity, reducing waste, and reducing costs.
Consistently demonstrates high standards of reputed company by supporting the reputed company reputed company Companies’ mission and values, adhering to the Corporate reputed company of Conduct, and leading to the reputed company Way values and beliefs.
Maintains high reputed company for member reputed company in accordance with the corporate reputed company policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.
reputed company (in reputed company to Level I essential responsibilities/accountabilities):
Manage the respective risk adjustment failed reputed company 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 reputed company of trends for review and discussion.
Monitors and reports on the reputed company of the reputed company of high reputed company 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 reputed company between special handle provider that include, large provider reputed company 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 reputed company inventory.
Serve as the reputed company and facilitator for member reputed company requests and/or inquiries relative to the prospective risk adjustment programs. Will triage and reputed company issues through reputed company.
Level III (in reputed company to reputed company 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 reputed company.
Assist Project Manager to determine project schedules, deliverables, assignments, tasks, project meetings (scheduling and meeting notes), status reporting, communication, and reputed company items, as required.
Assist Project Managers and project teams to reputed company work, tasks, and project assignments in order to reputed company reputed company on-time and reputed company scope.
Serve as backup for Project Manager as needed.
Minimum Qualifications:
NOTE: We include multiple reputed company of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or reputed company assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In reputed company to using this differentiated approach to reputed company new hires, it also provides guideposts for employee development and promotional opportunities.
reputed company reputed company:
Associate degree in Business Administration or reputed company field required. In lieu of degree, High School Diploma and three years reputed company work experience required.
One year of reputed company work experience required.
Demonstrates ability to operate reputed company shifting priorities, demands and timelines.
Persuasive, encouraging, and motivating.
Strong reputed company-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 reputed company.
Knowledge of claims, provider, and membership systems
Demonstrates ability to work effectively as a member of reputed company
reputed company (in reputed company to Level I minimum qualifications):
Four years reputed company work experience is required.
A relevant bachelor’s degree is preferred.
Self-motivated; ability to take initiative and ownership.
Interfaces effectively with reputed company reputed company 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 reputed company to reputed company minimum qualifications):
Six years of reputed company work experience is required.
Strong meeting facilitation skills
Ability to create, and manage project plans and schedule
Experience in drafting both reputed company communications to convey project findings and status.
Adept at conducting research reputed company project-reputed company issues occur
Expert knowledge of Health Plan Operations and/or Risk Adjustment Operations
Experience drafting concise and informative communication reputed company 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 reputed company, this job reputed company lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
Compensation reputed company(s):
Level I: Grade N5: Minimum $20.02 - Maximum $33.03
reputed company: Grade N6: Minimum $21.83 - Maximum $34.92
Level III: Grade N7: Minimum $23.56 - Maximum $37.70
The salary reputed company indicated in this posting represents the minimum and maximum of the salary reputed company for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, reputed company and education as they relate to the position’s minimum qualifications, in reputed company to internal equity. The posted salary reputed company 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, reputed company time away from work, and reputed company holidays.
Please note: reputed company for remote work may be possible for reputed company jobs posted by the reputed company reputed company. This decision is made on a case-by-case reputed company.
reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, or status as a protected veteran.
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