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  • 3225 Aviation Avenue
    Miami, FL 33133

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Valued Based Support Specialist

Femwell Group Health • Miami, FL

Posted 6 days ago

Job Snapshot

Full-Time
Experience - At least 3 year(s)
Degree - 4 Year Degree
Healthcare - Health Services
Health Care

Job Competition

9

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Job Description

Job Summary:

Responsible for Value based contract performance success relating to managed care, including but not limited to Pay for performance, Utilization, HEDIS requirements, shared savings, Medicare Risk Adjusted, claims management and contract metrics.

Essential Job functions:

Ø  Monitor and manage monthly financials and other key performance metrics by contract for practices.

Ø  Educate practices using the most current reporting tools to improve Medical Loss Ratio (MLR), Medical Risk Adjustment (MRA) and reduce medical spend through performance metrics.

Ø  Monitor physician performance for continuous improvement and revenue optimization and coaching practices on utilization and contract metrics.

Ø  Monitor financial performance as a group and timelines to achieve success in pay for performance, shared savings, bundled payment, partial and full risk contracts.

Ø  Meet quarterly with practices on value-based contracts performance to identify areas of improvements.

Ø  Meet monthly with payors on performance metrics based on the shared saving contracts/Incentive programs. 

Ø  Work collaboratively with the Quality Assurance department on Incentive programs for each payor.

Ø  Run reports and analyze data to assess meeting financial targets based on utilization.

Ø  Meet monthly with payors on performance metrics based on the shared saving contracts/Incentive programs.

Ø  Communicate with practices on value-based contracts regularly for coaching support in achieving bonus.

Ø  Oversee the performance and productivity of all shared saving contracts.

Ø  Report monthly to Director status on pay for performance outcomes.

Ø  Communicate effectively with providers, medical office staff, insurance carriers and internal departments to establish relationships.

Ø  Work Collaboratively with all payors and internal staff as well as support operational departments to achieve consistent goals.

Ø  Ensure all workflow items are completed within the set guidelines and with quality expectations.

Ø  Develops, maintains, and provides reports including data searches and/or analysis internally and with medical offices to ensure managed care information is distributed accordingly and appropriately.

Ø  Responsible for other job-related duties and projects as assigned.

 

Job Requirements

CORE COMPETENCIES REQUIRED:

Ø  Minimum of 3 years Managed Care Experience.

Ø  Medicare Risk Adjustment and Risk Contracting Knowledge.

Ø  Preferred Bachelor’s Degree.

Ø  Highly attentive to detail, accuracy and possess strong organizational skills.

Ø  Proficient in Excel reporting and manipulation.

Ø  Excellent oral and written communication skills.

Ø  High level work ethics, sensitive to confidentiality and can be trusted to be discrete as appropriate.

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