Responsible for performing routine and moderately complex activities under limited supervision in order to design, implement, maintain and support policies, processes and systems related to Medicare risk adjustment. Interacts with a wide variety of central support departments, as well as site and regional staff, to accomplish goals.
- Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
- Project management of programs by working with vendors and communities to set up and manage projects to completion.
- Monitors programs to ensure data flows through the system as expected.
- Maintains weekly program reporting for various audiences, reconciles program invoices, and calculates ROIs.
- Processes additional data into the system, ensures that data was processed and researches any interruptions to the process.
- Performs quality assurance on data and file submissions to Health Plans during CMS Sweep periods.
- Query, analyze, and interpret data for ad hoc analyses.
- Responds appropriately to and quickly resolves issues related to department applications or programs; manages customer expectations by keeping them informed of progress.
- Develops report specifications and creates complex reports for management or communities using available reporting tools.
- Gather information needed for compliance related activities.
- Participates in quality assurance process for all new department related system/application/process changes.
- Reconciles internal data to Health Plan data.
- Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
- Performs additional duties as assigned.
- Bachelor’s degree from a four-year college and/or equivalent work experience in a related field.
- Over 5 years and up to and including 7 years of experience.
- 3 to 5 years background in healthcare industry and managed care.
- 3 to 5 years experience with MS Access, Excel, and SQL.
- 3-5 years project management experience.
- 1 or more years CMS-Risk Adjustment experience.
- Experience with Business Intelligence Tools, such as Reporting Services and Analysis Services.
- Experience with SharePoint site development and maintenance.
Knowledge, Skills, & Abilities:
- Proficient in Microsoft applications (Access, Excel, Word, SQL).
- Strong analytical and problem-solving skills.
- Detail oriented.
- Experience in data and ad hoc analysis.
- Experience with working with large data sets and a variety of sources.
- Ability to work efficiently and accurately, while managing multiple priorities, in a fast paced environment.
- Proven ability to track and manage all projects, as well as on-going activities within a project.
- Good English verbal and writing skills.
- Ability to work in a team environment with minimal amount of supervision.
- Ability to transfer knowledge and information to teammates from a wide variety of cultural and educational backgrounds.
- Ability to cope with fluctuating demands of an uneven workload.
- Customer service-oriented.