Job description

• This resource will carry out the strategy to optimize quality performance while also ensuring that healthcare plan members have an excellent experience with the health plan
• This includes maximizing both quality and risk adjustment indicators in addition to assisting members navigate their health plan benefits
• Assist the provider group and the member by enhancing the coordination and removing points of abrasion between all three.
• Engage patients and shepherd them into care by scheduling appointments with their primary
• Ensure patients complete all relevant test and screenings in accordance with the NCQA HEDIS® recommendations
• Educate patients on and assist with navigating the various aspects of their insurance plan including but not limited to submitting prior authorizations, determining cost shares, obtaining referrals, checking formularies & finding in-network doctors/services
• Fulfill various requests (for patients’ charts, clinical information etc.) made of the provider by the health plan that are normally handled by the providers office staff

Job Types: Full-time, Contract

Pay: $34.00 - $38.00 per hour

Experience level:

• 5 years

Schedule:

• 8 hour shift
• Day shift

Application Question(s):

• Do you have knowledge of the Medicare, Commercial and Medicaid Risk Adjustment programs?
• Are you a certified risk adjustment coder?
• Do you have knowledge of Quality Concepts such as HEDIS, STARS, Medication Adherence, CAHPS & HOS?

Experience:

• Patient navigation: 3 years (Preferred)

Work Location: One location

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