Risk Adjustment Project Coordinator I/II/III

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 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.

• Educate providers of their contractual obligation to reputed company 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 reputed company 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 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 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 reputed company 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 reputed company 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 reputed company.

• 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 reputed company projects on-time and reputed company 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 reputed company assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to reputed company new hires, it also provides guideposts for employee development and promotional opportunities.

reputed company Levels:

• 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 a team

Level II (in addition 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 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 reputed company 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 reputed company project-reputed company 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 reputed company, 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, reputed company 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 reputed company jobs posted by the Univera Healthcare reputed company team. This decision is made on a case-by-case basis.

reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, disability, or status as a protected veteran.