Three to five years’ experience performing medical record coding in acute care setting. Working knowledge of Value Based Purchasing (VBP) Proficient at writing AHIMA complaint physician queries. High school graduate or equivalent.
5+ years recent experience in Managed Care in a regional or national health plan. 5+ years of experience leading large clinical projects and programs. 5+ years of experience as clinical program manager. Demonstrated ability to collaborate with senior physician and executive leaders.
Must be able to: Transcribe, edit, and interpret dictation by physicians and clinicians. Provide timely release of medical information to the EMR. Assist manager/director with mentoring/training of new team members. Skills and Requirements Include:
Effectively discover and address account needs. Train physicians with confidence and expertise. Skills and Requirements Include: Ability to work in the field. Bachelor’s Degree. Minimum of 5 years of field sales experience. Ability to manage territory operating budget.
Providing care coordination/case management through physician practices for members. Conducting telephonic member needs assessments according to state and national guidelines. Reviewing member charts prior to a physician appointment and create alerts/triggers to highlight Star opportunities.
At least 2 years of physician or healthcare sourcing/recruiting experience. Ability to demonstrate experience with various sourcing tools and technologies. 2 years of experience meeting or exceeding defined metrics.
Engage in detailed analytical reviews of physician medical records. Ensure unpaid accounts are worked correctly due to denials related to medical necessity. Qualifications for this position include: Attend in-house training. High school diploma or equivalent.
Interacting professionally with patient/family/physicians. Completing daily documentation, required letters, and referrals in a timely manner. Applicants must meet the following qualifications: Must be willing to train onsite in Northridge, M-F 830am-530pm.
Collaborating with Primary Care Physicians and other ancillary healthcare providers. Collecting member medical information from a variety of sources. Qualifications Include: Attend and participate required meetings, including staff meetings, internal Rounds, and other in-services.