Job Description

Location: Novato

Employment Status: Full Time

Position Summary

The Meritage Call Center Representative provides prompt, accurate and courteous responses to written and telephonic inquiries. These inquiries encompass numerous contacts and originate from subscribers, members, physician offices, and Health Plans; and typically involve a variety of issues including benefits, pricing, claim rejections, authorizations, and claim status.

Required Skills, Knowledge and Abilities

Ability to research and accurately resolve problematic claim situations

Multi-task and keyboard while researching, following-up, resolving and documenting telephonic inquires.

Knowledge of claim benefit interpretation/benefit adjudication logic

Must be proficient in problem solving and detecting trends

Excellent interpersonal, written and verbal communication skills

Must be able to read and interpret all types of authorization, medical claim forms and member benefit plans

Strong demonstrated customer service orientation

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Job Requirements

Education and Experience

High School Diploma or GED required

3-4 years previous claims customer service experience or call center

Familiarity of medical terminology preferred

Prior experience with medical coding (ICD10, CPT) preferred.

Customer service experience in a healthcare related field- HMO experience preferred.

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Job Description

Location: Novato

Employment Status: Full Time

General Statement of Duties

The Data Analyst will prepare relevant data analyses and reporting that helps departments meet their objectives and supports the business initiatives of the organization.

• Conduct ad-hoc analyses to identify strategic opportunities for improving patient care, increasing revenue, reducing costs, and finding operational efficiencies.
• Develop reporting of clinical, financial, and operational metrics for stakeholders; present and communicate findings.
• Maintain and improve upon data and reporting capabilities by developing new systems, processes, reports, and tools to deliver impactful and actionable insights that drive decision making.
• Gather, research and analyze clinical and claims data to help measure and improve performance against industry standards. Identify areas for improvement and opportunities for increasing incentive payments.
• Work with physician groups and independent practices across the Meritage Network to establish/improve quality data feeds for reporting to Meritage data vendors and health plans.
• Prepare productivity reports for related Medical Group physicians in order to ensure they are paid appropriately according to their contracts. Conduct ad-hoc analyses of productivity data per Medical Group requirements.
• Assist with the annual quality audit for the Align Measure Perform program.

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Job Requirements

Core Requirements

• Proficiency with data management and analysis tools such as: Microsoft Access, Power BI, and Excel
• Ability to quickly learn and master new software systems
• Experience working with relational databases with complex architecture and table structure
• Ability to develop and support in-depth reports that show nuanced and complicated clinical data, including the ability to teach end users how to interpret content
• Excellent written and verbal communication skills, including designing and presenting reports to internal and external groups
• An understanding of basic corporate finance principles
• Critical thinking and independent problem resolution skills
• Ability to prioritize workload to meet deadlines for short and long-term goals with competing timeliness.

Software and Tools

• High proficiency with Microsoft Excel
• Proficiency with or the ability to learn to work in a Microsoft Office environment: Outlook, PowerPoint, Visio, Excel, Word, Power BI, OneNote, etc.
• Proficiency with or the ability to learn to use project management and collaboration software: Asana, SharePoint

Education and Experience

• Ideally, 2+ years of data analysis experience
• Ideally, a background in at least one of the following areas: Risk Adjustment, HMOs, ACOs, Health Plans, Utilization Management, Case Management, Pay for Performance, 5 Star, etc.
• Bachelor’s degree or related study in one of the following areas: Statistics, Computer Science, Data Science, Informatics, Population Health, Healthcare Administration, Finance, Economics, etc., or a combination of education and experience.
• Curiosity and willingness to learn

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Job Description

Location: Novato

Employment Status: Full Time

Position Summary

 Clinical Coding Specialists are responsible for reviewing patient medical records for Medicare Advantage enrollees, and other groups/populations as assigned, to identify chronic conditions to be prioritized and addressed by healthcare providers. The review process includes working with multiple electronic health records, completing of pre-appointment reviews, completing post appointment reviews and reviewing capture of chronic conditions for physician incentives.  They must maintain best practices for accurate data collection and adhere to Meritage policies and procedures.

Primary Responsibilities

• Evaluate the patient’s medical record and reports from the health plan to identify and document potential chronic conditions to be addressed by healthcare providers.
• Complete post-appointment review to assess HCC capture by providers and document findings.
• Work with team to ensure ICD10 codes submitted by physicians are supported by documentation and provide feedback to inform physician education.
• Review, assess and provide feedback to mid-level providers conducting home visits.
• Document any additional HCC codes, when clinically indicated, on the ICE file.
• Report any findings of noncompliance for issues not related to HCC in the Secondary Pursuit file.
• Collaborate with team members to research or answer any coding questions that may arise.
• Assist in education of providers and staff regarding coding procedures and policies to ensure compliance.
• Respects patients by recognizing their rights and maintaining confidentiality.
• Promotes a team approach by encouraging communication among all members of the care team.
• Contributes to the team’s effort and success by accomplishing delegated tasks on time and meeting his/her daily and weekly job goals.
• Communicate with providers regarding HCC capture via the EHR tasking system.
• Maintain excellent customer relationships with providers, medical office staff, other department staff and health plan representatives.
• Complete assigned tasks daily and in a timely manner.
• Maintain current coding credential (if applicable).
• Assist in the training and orientation of new staff as directed.
• Performs other duties and projects as assigned that support the Care Management Team and other areas, departments and programs within the Meritage organization.

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Job Requirements

Qualifications 

• Minimum of 1-2 years current medical background with chart review experience.
• Working knowledge of medical terminology, anatomy and physiology, disease processes and pharmacology.
• Able to work effectively on an independent basis or as part of a larger work team.
• Demonstrates critical thinking skills, sound judgement and a solid sense of accountability.
• Able to concurrently use different electronic health record systems as needed.
• Detail oriented and able to work as a collaborative and positive team member.
• Strong written, verbal and listening communication skills.
• Expertise in ICD-10-CM and CPT and RAF.
• Demonstrates a professional demeanor and excellent customer services skills
• Treats others in a respectful, kind and patient manner
• Self-motivated and able to ask for assistance when needed.
• Unrestricted driver’s license and automobile insurance.
• Flexible and adaptable to change.

Education and Experience Requirements:

• Graduate of an accredited coding program with coding certification is strongly preferred, CMA program, or current applicable medical office/chart review experience.
• One year of previous recent procedural/diagnosis coding, or equivalent work experience.
• Two years of customer service experience in a healthcare related setting.

 

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Job Description

Location: Novato

Employment Status: Full Time

Summary of Duties and Responsibilities

The Patient Care Programs Coordinator will provide administrative support to two programs, the Risk Adjustment and the Medication Adherence programs and have different duties in each program.

Risk Adjustment program:

• Provide Administrative support to Risk Adjustment Manager and Meritage clinical coders
• Enter appointments, upload/print documents from third party data base.
• Communicate with physician offices
• Assist during audits/chart chase

Medication Adherence Program:

• Extract qualified patient lists from Health Plan reports
• Follow up with non adherent members
• Use MA guidelines to help patients with adherence and coordinate with Care Management team

 

Go to application

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Job Requirements

Qualifications

• Highly organized, effective at managing her/his time
• Skilled in the use of computers and multiple software systems and applications.
• Demonstrates critical thinking skills and sound judgement
• Comfortable speaking on the phone with patients, physicians and office staff
• Remains professional and objective in relationships with patients, families and physicians
• Promotes a team approach by encouraging communication among all members of the care team.
• Excellent professional written and verbal skills
• Demonstrates a professional demeanor and excellent customer services skills
• Ability to function in a team with patients, families, physicians, MD office
• Self-motivated and able to ask for assistance when needed
• Possess a strong sense of accountability for work performed and in meeting deadlines
• Flexible and adaptability for change

Education and Experience Requirements

• A minimum of 2 years’ customer service/ administrative experience in a front or back medical office or related setting.
• Basic understanding of the healthcare vocabulary (i.e. medications, different conditions, proper documentation)
• Or an equivalent combination of education, certification and work experience.

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