RISE Job Board

Harvard Pilgrim Health Care is currently seeking highly motivated individuals to join our growing Medicare Advantage organization in the following roles.

  • Are you interested in becoming part of a dynamic team that is looking to innovate and improve? 

  • Would you like to work for a company that has been rated by the Boston Business Journal (15+yrs) as one of the best places to work?

  • Do you want to be part of a company that is committed to giving back to the community? 

Medicare Payment Integrity Lead.  

The Medicare Payment Integrity Lead is responsible for the overall management of Medicare Advantage claim payments and other related transactions such as referrals, authorizations and capitation configurations to ensure accurate, timely and efficient claims processing in accordance with CMS and other State specific regulatory requirements.  Read more about our Medicare Payment Integrity Lead opportunity at https://careers.harvardpilgrim.org, Job # 170000A3 

Sr. Medicare Advantage Data Operations Specialist 

The Sr. Medicare Advantage Data Operations Specialist is responsible for being the business lead, technical subject matter expert, analyst and data quality steward responsible for maintaining and communicating guidelines to ensure a continual state of organizational readiness to produce timely and compliant data submissions for CMS and other regulatory and operational audits of transactional data.  Read more about our Sr. Medicare Advantage Data Operations Specialist opportunity at https://careers.harvardpilgrim.org,Job # 170000A1

 

Director of Risk Adjustment

Location:  Fort Worth, TX

Salary Range:  110k-140k DOE

Resume submissions to:  ctrevino@ntsp.com

Job Description:

Under the general supervision of the VP of Risk Adjustment and Quality, this position provides Strategic Direction to the Risk Adjustment Department in order to meet or exceed specified targets.  Responsible for the development of prospective programs in collaboration with Provider Engagement for effective provider education and training.  This position is responsible for the management of the retrospective medical record review process.  Ensures department and systems are prepared for and management of RADV audit process and other similar audits.  The Director will also be responsible for supervising the Risk Adjustment Department.  Assist with development, implementation and measuring initiatives that will meet/exceed our targets for risk.  Responsible for developing and ensuring accuracy of Risk Adjustment dashboards / glide-paths to assess our progress.  Works collaboratively with Expense Management, Quality and Finance departments to ensure optimal management of the risk adjustment process.

KEY ACTIVITIES

• Develops strategy for achieving Risk Adjustment targets incorporating all CMS standards and timelines.

• Direct supervision of Risk Adjustment department.

• Responsible for reporting including weekly review with Executive team.

• Responsible for vendor supervision as it relates to Risk Adjustment.

• Coordinates monitors and summarizes CMS risk adjustment projects for primary care physicians, utilizing outside coding review agency.

• Develops, implements, and/or maintains documentation consistent with CMS regulations, company goals and policies.

 

Educational Requirements:

• Requires a Bachelor’s Degree and 3-5 years’ experience in related field.

• Master’s Degree in a health management / business management area highly preferable

• Certified Risk Coder certification desirable

 

Experience: 

• 5+ years of health plan experience working with Medicare and Medicare Advantage programs focusing on revenue cycle management.

• Requires working knowledge of CMS and risk adjustment methodologies.

• Operational knowledge of provider relations, claims, and medical management is highly desired.

• Knowledge of HCC coding a plus.

• Must possess strong organizational, analytical, financial, communication and presentation skills.

• Exclusion from Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment.

 

Skills or Special Abilities:

• Ability to think strategically to develop new initiatives/processes that will achieve our specified targets.

• Provide clear, appropriate and timely communication to promote a team environment throughout the department and NTSP system.

• Excellent problem solving, communication, and organizational skills

• Ability to motivate team and hold team accountable for the results

• Ability to handle multiple projects and heavy workloads

• Ability to work effectively as an interdisciplinary team as well as independent.

• Excellent knowledge of file transfer and audit processes as they relate to Risk Adjustment.

• Excellent knowledge of Microsoft Office (Excel, Word, PowerPoint) 

CAROL TREVINO

Recruiter

North Texas Specialty Physicians

1701 River Run, Suite 607

Ft. Worth, TX 76107

T:  817-687-4046, ext. 1126

Fax:  817-632-1743

ctrevino@ntsp.com

www.ntsp.com

 

Nurse Coder

Location:  Fort Worth, TX

Salary Range:  45k-55k DOE

Resume submissions to:  ctrevino@ntsp.com

Job Description:

This position is responsible for conducting and analyzing data collected for patterns and trends to identify opportunities to improve documentation and coding for providers. Responsible for reviewing inpatient and outpatient hospital records, and outpatient physician records for the purpose of identifying and submitting documented diagnoses to CMS for client members of Medicare Advantage plans. The position interacts with a variety of internal and external clients including physicians, provider office personnel and billing staff. This position requires high level interpersonal skills. This position will report to the Sr. Manager of Risk Adjustment Coding.

KEY ACTIVITIES & CORE COMPETENCIES

  • Customer Focus: Establish and maintain effective relationships with customers and gain their trust and respect.
  • Communication: Present ideas and facts, both orally and in writing, in a clear, concise manner. Listen to input from others and verify that the client and staff members understand the purpose and scope of the project. Skillful use of various forms of communication is extremely important. (i.e., phone, fax, e-mail, voice mail, and meetings); ability to maintain composure and professionalism in stressful situations is key.
  • Technical/Job Knowledge: Understand and perform the technical and professional requirements of the position; demonstrate willingness and ability to learn and apply new concepts. Must be flexible and detailed oriented.
  • Teamwork: Meet team goals by ensuring individual actions are aligned with the team’s needs.
  • Ethics and Values: Build sustainable, positive relationships that result in trust and a cooperative work environment; treating clients and co-workers with respect.
  • Diversity: Work with diverse population equitably dealing individuals of all ethnicities, nationalities, cultures, disabilities, age and gender.
  • Initiative: Take personal responsibility for getting “the job done"; ensures understanding of roles, responsibilities and performance expectations, ensure activities are prioritized to achieve desired results; seek direction to maximize performance when lack of clarity exists.
  • Continuous Improvement: Is dedicated to providing the highest quality services to meet the needs and requirements of internal and external customers; commitment to continuous improvement through management by data; must be open to suggestions and change.

 

MAJOR RESPONSIBILITIES:

  • Perform chart audits in hospital records by reviewing clinical documentation against supporting information in the medical record, claims data and coding information.
  • Participate in Case Conferences to help identify high risk members and assess the needs of the member for Risk Adjustment, Quality gaps, and cost control.
  • Identify any chronic conditions coded in the previous year and make recommendations for the current year and review labs, x-rays, pathology and other various reports to identify suspected conditions and make suggestions for new code captures.
  • Identify opportunities; provide guidance and suggestions for quality and performance improvements in the collection and recording of clinical documentation.
  • Special projects as needed.
  • Be in line with all company goals and policies.
  • Analyze data collected for patterns and trends to identify opportunities to improve documentation.
  • Record findings completely and accurately in accordance with ICD-9 and ICD-10 coding guidelines.

 

EDUCATION

  • Required Current licensure through the State of Texas for an RN or LVN with preferred CPC or CCS through AAPC or AHIMA.
  • Coding certification is not mandatory.

 

EXPERIENCE

  • Preferred (but not mandatory) experience in HCC Medicare medical record review in an outpatient setting, strong knowledge of ICD-9-CM and ICD-10.
  • Minimum of at least 3 years of coding experience in an outpatient or inpatient setting.
  • Demonstrate a strong knowledge of ICD-9 and ICD-10 coding guidelines and preferred understanding of CMS Risk Adjustment HCC model.
  • Ability to work independently in a fast paced environment.
  • Basic computer skills (word, excel and power point presentations)
  • Critical thinking skills and ability to work with minimal supervision.
  • Assertive and excellent communication skills.

 

CAROL TREVINO

Recruiter

North Texas Specialty Physicians

1701 River Run, Suite 607

Ft. Worth, TX 76107

T:  817-687-4046, ext. 1126

Fax:  817-632-1743

ctrevino@ntsp.com

www.ntsp.com

 

 

 

Lead Program Manager, Medicare Stars

Blue Cross Blue Shield, North Carolina 

 Develop work plans and lead staff responsible for managing programs and/or improvement initiatives with varying levels of complexity. Independently manage, plan, design and develop multiple or large complex programs/initiatives focused on improving processes, reducing costs, increasing productivity, improving divisional outcomes and/or enhancing relationships internally and externally. Responsible for all aspects of program/initiative management including strategic planning, needs analysis, content development, data analysis, vendor selection and management and contract management. Utilizes significant expertise in these disciplines to successfully support teams and overall program/initiative and enterprise goals.

 ***Medicare experience strongly preferred

Hiring Requirements

  •  Bachelor’s degree and 7 years experience in program or project management in the area of program specialization
  • OR Master’s degree and 5 years experience in program or project management in the area of program specialization
  • In lieu of degree, a minimum of 9 years of program or project management experience in the area of programs required.
  • Should have direct experience with the management of large, complex programs and/or successfully management of multiple projects/programs simultaneously.
  • Prior leadership experience is required.

 For more information, please visit JOB ID: RQ0002274 https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC/job/Durham/Lead-Program-Manager---Medicare-Stars_RQ0002274

 

Clinical RA Coding and Quality Educator - North Texas Specialty Physicians 

General Functions:

  • Assist in the collection and analysis of qualitative and quantitative data as it relates to risk adjustment specifically around missed opportunities, prevalence and suspects. 
  • Assist in the design and development of ad hoc reports and presentations for risk adjustment initiatives.
  • Meet with organizational leadership to partner on Physician Risk Education strategy
  • Ability to communicate and interact positively and professionally throughout all levels of the organization and with external customers.
  • Assist with the development and utilization of training and attendee tracking metrics and methodologies.
  • Assist with the development of physician and staff coding remediation plans where appropriate including provider assessment and scorecard. 
  • Monitor education programs, timelines, learner progress and report to leadership when appropriate.
  • Provides onsite instruction per location (practice/clinic) for physician practice and office staff with ICD-9-CM /  ICD-10-CM coding training focusing on Medicare Risk Adjustment documentation and coding opportunities.
  • Provides instructional review of ICD-10-CM translations specific to Medicare Risk Adjustment-type diagnosis codes.
  • Performs outreach on Risk Adjustment Education based on review of pre-selected charts coupled with data management, data reporting and analysis, and provider scorecards. 
  • Consistently demonstrates the ability to speak and present at outreach events professionally with strong analytical, problem-solving and critical thinking skills.

MINIMUM EDUCATION: 

  • Certified Coder / Trainer

 PREFERRED EDUCATION: 

  • Bachelor degree in Nursing or Healthcare degree with 5 to 7 years’ experience training providers on Medicare Advantage Risk Adjustment documentation. 

 MINIMUM EXPERIENCE:

  • Education and training experience with strong organizational skills in multiple settings, as well as the ability to exercise sound judgment and initiative.
  • Strong presentation skills.
  • Excellent problem solving and the ability to handle multiple projects, heavy workloads and deadlines in a fast paced dynamic environment.
  • Self-motivated with excellent follow through skills with ability to work independently with minimal to moderate supervision with demonstrated ability to work as an effective team member.
  • Strong working knowledge of MS Office products, including PowerPoint, Excel and Word
  • Adobe Captivate, Articulate and/or MLS relational database knowledge desired.
  • Have minimum of 5 years’ Healthcare / Coding / Education / Quality experience. 

 PREFERRED EXPERIENCE : 

  • Medicare Advantage coding and documentation

 REQUIRED CERTIFICATIONS/LICENSURE:

  • CPC, CPC-I, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA, CPMA or CRC required

 PREFERRED CERTIFICATIONS/LICENSURE:

  • RN, LVN, BSN, PA or NP

Please return all resumes to our NTSP Career email of careers@ntsp.com.  Altenatively, they can be directed to: Carol Trevino, recruiter at ctrevino@ntsp.com

  

Job Title: Risk Adjustment Data Analyst

Company:  Health Partners Plans             Location: Philadelphia

General Description: 

The Risk Adjustment analyst will be responsible for compiling, verifying, and analyzing data for trend and other analyses related to Risk Adjustment.  This person will be collecting and analyzing healthcare related data by performing data management and quality improvement studies on that data and producing the resulting reports.  The Analyst will develop expert knowledge of the Center for Medicare & Medicaid Services (CMS) – Hierarchal Condition Categories (HCC) and University of California San Diego (UCSD) Chronic Illness and Disability Payment System (CDPS) risk adjustment model, its concepts and methodology in order to reconcile CMS and Department of Human Services (DHS) risk score reports, project future revenue related to risk adjustment and evaluate financial impacts of risk adjustment initiatives.  Reports, Analysis results and actionable information will be shared with providers and senior management.

Posting Link:   click here to go to job posting on company website      

 

Job Title:  Email Marketing Manager for EpiSource

Division:  Sales & Marketing

 Your opportunity at Episource is to simplify healthcare!  

Are you a rockstar marketer with hands-on email marketing experience? If so, Episource is looking for a results-oriented, driven individual to manage email marketing programs that will drive brand awareness, engagement, and retention. If you’re analytical and metrics oriented with a desire to work for a dynamic and fast-growing healthcare company, this role may be for you.

Responsibilities:

  • Full ownership of email marketing campaigns including planning, setup and execution using a marketing automation platform (Pardot) and CRM (Salesforce)
  • Manage and segment our lead database to maintain data integrity, optimize targeting, and improve delivery and response rates
  • Collaborate with various teams to create email template designs, call-to-actions, content, and subject lines that follow email best practices
  • Provide tactical planning solutions for future workflows and strategy based on results (clicks, opens, site visits, page visits, return visits, conversions)
  • Analyze and report on specific campaigns, objectives, results and KPIs highlighting success, trends and opportunities
  • Ensure communication with our audience is excellent and in alignment with brand guidelines

 Qualifications:

  • BA/BS in Marketing/Communications/Business or equivalent relevant working experience
  • 2-4 years of hands-on experience with email marketing automation
  • Experience with Salesforce a big plus, Google analytics experience a plus
  • Highly analytical with the ability to read data and make recommendations for future enhancements to our messaging and content
  • Positive attitude with the ability to manage change, thrive in a fast-paced environment, deal with ambiguity, and prioritize multiple projects 
Click here to download full description

If interested, please send your resume and cover letter to accountsupport@episource.com

January 31, 2017

 

Job Title:  Sales Development Representative for EpiSource (Exempt)

Division:  Sales & Marketing  Reports to:   SVP Sales & Marketing

Your opportunity at Episource is to simplify healthcare!  

  • Episource leverages data to provide patient insights and drive interventions. As thought leaders and subject matter experts, we are constantly striving to identify actionable insights. We service the $3.0 trillion healthcare space and our clients represent leading organizations throughout the United States.
  • Episource is at the forefront of the ever-evolving healthcare marketplace. We help clients paint an accurate picture of patient health profiles by analyzing medical records, claims, and clinical data sets.
  • We have grown significantly to support the regulatory changes over the last 10 years, and are poised to continue our expansion as the leader in the marketplace.


The Challenge you will face:

  •  We have proven that we can close, deliver, and grow customer accounts. We need a strong communicator to engage prospects captured from marketing and drive interest in Episource’s services.
  • Through dialog, create brand awareness and quickly establish Episource as an industry leader with companies that may or may not be familiar with us.
  • This is a new opportunity within Episource that allows someone to implement sales techniques and tools that they’ve used in the past to help guide the growth of this function within the company.
  • We are an entrepreneurial and fast-growing company. You need to be disciplined and tenacious to overcome client objections. You need to roll up your sleeves and deliver.

 Doing the right things:

  • Build a valuable and convertible pipeline. You will be the expert at engaging potential customers through email and phone to qualify for relevance and fit.
  • Conduct research (social, online, Linkedin) to identify the right target accounts and contacts to pursue.
  • Effectively communicate (speak and listen) with potential customers, think on your feet, and overcome objections to quickly establish credibility and build rapport.
  • Strong written communication skills to provide insight to sales executives once sales opportunity is created.
  • Put your stamp on building scalable, repeatable processes.
  • Take initiative and accountability for own success.

 Changing the World (and Your Career):

  •  You will be the face of Episource and our efforts to simplify healthcare.
  • You will be responsible for initiating 10 prospect meetings per month.
  • You will create a qualified sales pipeline in excess of $3M.
  • Your contribution will support closing of $1M in revenue annually.
  • Your contribution will have huge impact on Episource’s growth.
  • You’ll love crushing goals with us!  
Click here to download full description

If interested, please send your resume and cover letter to accountsupport@episource.com

January 31, 2017

 

Job Title:  Sales Executive for EpiSource (Exempt)

Division:  Sales & Marketing    Reports to:   SVP Sales & Marketing

Your opportunity at Episource is to simplify healthcare!  

  • Episource leverages data to provide patient insights and drive interventions. As thought leaders and subject matter experts, we’re constantly striving to identify actionable insights.  We service the $3.0 trillion healthcare space and our clients represent leading organizations throughout the United States.   
  • Episource is at the forefront of the ever-evolving healthcare marketplace. We help clients paint an accurate picture of patient health profiles by analyzing medical records, claims, and clinical data sets.
  • We’ve grown significantly to support the regulatory changes over the last 10 years, and are poised to continue our expansion as the leader in the marketplace.  

The Challenge you will face:

  •  We’ve proven that our value proposition resonates, our services deliver great value and we can grow customer accounts. 
  • We need a strong hunter to help broaden our customer base to further our growth and successes in simplifying healthcare. It will require aptitude to learn our healthcare market in order to converse credibly with clients.
  • Identifying the right target accounts and contacts will require your leadership and understanding of our value proposition and healthcare marketplace. Building a sustainable pipeline is critical to your success.
  • In a demand-rich market, selecting the best opportunities to pursue that are winnable, desirable, and deliverable is key to success. Your leadership is required to focus the team on winning.
  • We are an entrepreneurial and fast-growing company. You need to create value-based relationships that allow our services to shine. You need to deliver.

Doing the right things:

  • Build a valuable and convertible pipeline. You will be the expert at engaging potential customers throughout their buyer journey to create successful long-term client relationships
  • Conduct research (social, online, Linkedin) to identify the right target accounts and contacts to pursue
  • Effectively communicate (speak and listen) with potential customers, think on your feet, and overcome objections to quickly establish credibility and build rapport
  • Drive the lengthy buying process from prospecting to closing of deals valued at $200k - $1M+. This involves education, support in developing RFPs and competently working with buyers in understanding the benefits of switching to our solution vs. competitive offerings or the status quo. It also involves aligning to our sales process and salesforce platform to communicate internally on progress.
  • Proven history of sales success
  • Take initiative and accountability for own success while knowing when to ask for help.   
Click here to download full description

If interested, please send your resume and cover letter to accountsupport@episource.com

January 31, 2017

 

 

Clinical RA Coding and Quality Educator,

North Texas Specialty Physicians, Ft. Worth, TX

 General Functions:

  • Assist in the collection and analysis of qualitative and quantitative data as it relates to risk adjustment specifically around missed opportunities, prevalence and suspects. 

  • Assist in the design and development of ad hoc reports and presentations for risk adjustment initiatives.

  • Meet with organizational leadership to partner on Physician Risk Education strategy

  • Ability to communicate and interact positively and professionally throughout all levels of the organization and with external customers.

  • Assist with the development and utilization of training and attendee tracking metrics and methodologies.

  • Assist with the development of physician and staff coding remediation plans where appropriate including provider assessment and scorecard. 

  • Monitor education programs, timelines, learner progress and report to leadership when appropriate.

  • Provides onsite instruction per location (practice/clinic) for physician practice and office staff with ICD-9-CM /  ICD-10-CM coding training focusing on Medicare Risk Adjustment documentation and coding opportunities.

  • Provides instructional review of ICD-10-CM translations specific to Medicare Risk Adjustment-type diagnosis codes.

  • Performs outreach on Risk Adjustment Education based on review of pre-selected charts coupled with data management, data reporting and analysis, and provider scorecards. 

  • Consistently demonstrates the ability to speak and present at outreach events professionally with strong analytical, problem-solving and critical thinking skills.

 MINIMUM EDUCATION: 

  • Certified Coder / Trainer

 PREFERRED EDUCATION: 

  • Bachelor degree in Nursing or Healthcare degree with 5 to 7 years’ experience training providers on Medicare Advantage Risk Adjustment documentation. 

 MINIMUM EXPERIENCE:

  • Education and training experience with strong organizational skills in multiple settings, as well as the ability to exercise sound judgment and initiative.

  • Strong presentation skills.

  • Excellent problem solving and the ability to handle multiple projects, heavy workloads and deadlines in a fast paced dynamic environment.

  • Self-motivated with excellent follow through skills with ability to work independently with minimal to moderate supervision with demonstrated ability to work as an effective team member.

  • Strong working knowledge of MS Office products, including PowerPoint, Excel and Word

  • Adobe Captivate, Articulate and/or MLS relational database knowledge desired.

  • Have minimum of 5 years’ Healthcare / Coding / Education / Quality experience.  

Contact:  Please have all resumes return to our NTSP Career email of careers@ntsp.com.  You may also contact Carol Trevino, Recruiter, at ctrevino@ntsp.com

Click here to download full description
 January 23, 2017

 

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This is your can't-miss opportunity to gain proven strategies for enhancing the compliance of your coding and risk adjustment data. You also will get unparalleled insight and tools to help streamline the integration of risk adjustment and quality initiatives, and take away critical lessons learned from plans breaking down operational silos. You will also hear directly from CMS! 

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Meeting and exceeding quality standards has never been more important for health plans as reimbursement is increasingly linked to specific quality goals. This informative webinar will help you understand how to gain control over meeting your quality goals by executing targeted interventions for those members with gaps in care. You’ll get a glimpse of how to coordinate everything from member outreach and engagement, to actual gap closure and reporting to the member, their primary care provider and the health plan.

 

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