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

The Database Application Developer is a full-time exempt position within an existing cohesive IT team, reporting to the CIO.

Using technical skills and business acumen, the Database Application Developer will be able to take business questions and translate them to timely and accurate requirements by using in-depth understanding of the health care industry. The individual will have a passion for data process design and process automation. The individual will have strong command of SQL with the ability to manipulate, aggregate, and transform data for reporting purposes. Working with a team of other database developers and software programmers, the Database Application Developer will be supporting our internal SQL Server database processes, MS Access desktop applications, and VB.NET web applications.   The Database Application Developer will have strong familiarity with industry standard file structures such as EDI and HL7.

RESPONSIBILITIES
Design and develop SQL Server databases and MS Access applications that support the administrative and clinical reporting needs of the company.

Create, maintain, and expand custom VB.NET HL7 parsers.

Design and develop ASP.NET APIs and back end processes.

Work with a team of other developers leveraging best practices and standards.Design and develop test cases to validate new data and changes to the existing code.

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Job Requirements

EDUCATION
Bachelor’s degree in Computer Science or related quantitative area of study.

EXPERIENCE
Five plus years of experience working on automated processes with large databases.Strong SQL data manipulation skills, including data transformation, aggregation, and summary reporting.
Experience with Structured Programming Languages such as C#, VB.NET, Java.

Prior experience working with Angular JS a plus.

Exceptional qualitative, quantitative, analytical, and problem-solving skills and attention to detail.

Healthcare experience preferred.

Experience with Agile development methodologies preferred.

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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

 

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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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Job Description

Location: Novato, California

Employment Status: Temporary 2 months or more TBD

General Statement of Duties

The Senior Accountant prepares consolidated financial statements including balance sheets, income statements, and cash flow statements. Reviews and analyzes account balances, verifies accuracy, prepares reconciliations and other supporting schedules, investigates issues and makes recommendations for corrections. Develops and enhances accounting/finance applications and reports based on management needs for performance measurement. Provides guidance, assistance and back-up to other accounting and support staff as required/assigned, including revenue, accounts receivable/payable, payroll, and provider compensation.

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Job Requirements

Education, Experience and Qualifications

• Bachelor’s degree in accounting. CPA or CPA-ready is preferred or a combination of experience and education.
• Minimum 5 years of current professional hands-on accounting experience including 3-5 years in a health care organization, managed care environment preferred. Additional experience with accounts payable and payroll is a bonus.
• Ability to work at an advanced level with Excel and accounting applications (Microsoft Dynamics Great Plains or similar).
• Ability to perform mathematical computations and compute ratios and percentages.
• Skill in defining problems, collecting data, interpreting financial material.
• Skill in preparing statistical and narrative accounting and auditing reports
• Ability to communicate clearly and to maintain effective working relationships.

 

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Job Description

Location: Novato

Employment Status: Full-Time

The Utilization Management Coordinator LVN serves as a liaison between Meritage Medical Network, our contracted health plans, Network physicians and Members. The incumbent will serve as a resource to other UM team members and is responsible for processing authorizations within the scope of their assignment. This position reports directly to the UM Manager.

Principle Duties and Responsibilities:

• Utilize knowledge and experience to analyze contractual or administrative issues related to the requests.
• Identify additional information needed and ability to research and understand Policy benefits and criteria
• Accurately identify when and how to refer cases to appropriate clinical personnel or take other actions as necessary or required.
• Follow strict guidelines to ensure all work meets ICE standards for accuracy, timeliness, quality and compliance with federal, state and accreditation regulations.
• Coordinate with other insurance coordinators and the medical review staff.
• Consistently meet department productivity and performance metrics.
• Contribute to the efficiency of the department by being flexible and cross-trained on other functions.

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Job Requirements

Minimum Qualifications:

• Two years of current related Utilization Management experience required; Managed Care or health plan experience strongly preferred
• Current and unrestricted CA LVN license preferred; Medical Assistant certificate and additional relevant work experience will be considered in lieu of LVN licensure.
• Must have the ability to understand and use set criteria and approve specific services within the related UM system.
• Familiarity with insurance billing and medical terminology
• Knowledge of CPT/ICD-10 codes.
• Excellent interpersonal skills, including phone, verbal, and written communication.
• Ability to cope in a fast-paced production environment
• Demonstrated knowledge of customer service skills when responding to questions and other inquiries from internal and external customers.
• Strong computer skills with demonstrated proficiency in word processing, spreadsheet, database, presentation and email applications.
• Must be organized and detail oriented

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