Job Description

Location: Novato & SF North Bay

Employment Status: Full Time

As a key member of the Network Relations Department, serves as a liaison for assigned geographic regions between Meritage and networked Ancillary Services e.g. Skilled Nursing Facilities, DME Providers, Laboratory Services offices, traveling to and handling matters including but not limited to:

• Providing orientation on the Meritage Medical Network for new network providers and their office staff, including an overview of Meritage staff, resources, procedures, services, and applicable contact information
• Introduction, overview and explanation of new and existing Meritage services and programs available to network providers
• Provides initial and ongoing (i.e. monthly or quarterly), education and training to providers and their staff on accessing Meritage services and programs, policies and procedures, and updates and changes to the network

Maintains a regular and ongoing presence at the ancillary services offices to build and maintain strong, trusting and professional working relationships with providers, practice managers and office staff.  Helps Meritage better understand the needs of the physician offices in order to develop new and effective strategies to support their success.  Spends approximately 1-2 days per week working in the field with network provider offices and 3-4 days at the Meritage office planning and preparing for site visits; however, this allocation of time in the provider offices and at Meritage is subject to change based on work volume, provider needs and business objectives.

PLEASE NOTE: Given current safety guidance due to the COVID19 pandemic the presence required in the physician office is remote.

Duties and Responsibilities

1. Maintains a sound and comprehensive understanding of all Meritage services and staff and how they support network physicians in order to serve as an effective and credible Meritage representative to those practices.
2. Develops physician/provider and office staff information and education materials for distribution in the field.
3. Works to ensure that the Meritage name and brand is present and visible in network practice offices to underscore and support the relationship between Meritage and the practice to office staff and patients.
4. Involved in development and coordination of updates and dissemination of the Network Quarterly newsletter to physician practices.
5. Participates in the preparation, coordination and hosting of network physician social events such as the annual mixer as well as Practice Manager social events.
6. Coordinates Regional Operations Committees and Membership Committee meetings, including but not limited to developing and maintaining committee lists, developing and sending out invitations, save the date reminders, reserving meeting locations, meal coordination, developing and disseminating meeting agendas and materials, taking and disseminating meeting minutes, and maintaining all records and associated databases.
7. Assists onboarding new member physicians and guides them and the practice staff through the Membership process. Ensures all documentation is collected, working closely with the Credentialing Coordinator.  Dispersing member physician contracts and getting signatures.
8. Tracks and monitors ongoing provider issues.
9. Regularly gathers data from practices on matters and topics such as physician satisfaction, patient access, service needs and requests that would help the practice be more successful.
10. Serves as a primary liaison between network physicians and their office staff, and Meritage representatives in the Utilization Management, Claims, Care Management, QA, Contracting and administration for the provision of service, education and training and problem resolution.
11. Makes recommendations to Meritage leadership regarding ways that the organization could be a better and more valued resource and partner to network providers and the staff.
12. Performs other duties as assigned related to supporting the Network Relations Department and the overall Meritage organization.

Go to application

---

Job Requirements

Minimum Requirements and Competencies:

1. Strong demonstrated customer services skills and commitment.
2. Strong organizational skills with an attention to detail and the ability to multitask and juggle multiple priorities effectively.
3. Demonstrated excellent written and verbal communications skills, with ability to prepare and present effective individual and group presentation materials.
4. Professional demeanor and work style that projects a confident, open, capable and trustworthy persona that is able to be sustained and maintained in all initial and subsequent interactions with customers and community representatives.
5. Ability to confidently and clearly present information in a large group setting.
6. Must possess strong listening skills with the ability to make the customer feel as though s/he has been heard and that his/her input, concerns and suggestions are valued and will be taken seriously.
7. Working knowledge, experience and expertise with office-based computer equipment and systems including but not limited to: Word, Excel, PowerPoint, Outlook, as well as other medically related databases and software applications.
8. 3-5 years’ experience working with physician and physician practices, their staff and affiliated businesses, e.g., 3^rd party suppliers and vendors, insurance companies, etc.
9. Bachelor’s degree in a related healthcare or business field with 3 years directly related work experience; or equivalent combination of education and work experience. Healthcare related sales training and/or experience is a plus.
10. Ability to exercise and be accountable for independent judgement and decision making on organizational and network issues
11. Upon hire, must provide a current Driver License and proof of insurance.

---

Apply Below

Job Description

Location: Novato, CA

Employment Status: Full Time

Position Summary

The Senior Financial Analyst is responsible for the production of analyses, projections, routine and Ad Hoc reporting to support the decision making functions of MMN management and Individual Practice Association (IPA), Medical Group leadership, as well as collaborating with identified internal and external partners with analyses including, but not limited to new or expanding programs and lines of business for MMN.

• Provide support of business plan development, Professional Services Agreements (PSA) administration, and provider productivity reporting.
• Assist in the development of financial and productivity related performance reports for the IPA and Medical Group providers and MMN and Medical Group Care Center Operations.
• Assist in the development of information delivery to optimize the use of financial resources.
• Responsible for overseeing the production of a wide variety of routine recurring reports and analyses, e.g. productivity reports, payer-mix analyses, health plan and regional P&Ls, trends, benchmarking, scorecards, and dashboards.
• Responsible for business case development related to possible acquisitions in existing business lines.
• Provide key financial and statistical information for the long-term forecast development.
• Develop appropriate benchmarks, the identification of trends and variances, and an assessment of underlying business practices.
• Emphasize opportunities to control and reduce costs. Plans for the short and long-term financial needs of the organization.
• Assure optimum utilization of financial resources through sound forecasting.
• Participate in strategic business planning and monitors and tracks progress towards meeting identified initiatives and efforts.
• Responsible for market and demographic research requests regarding the entry into new markets and/or lines of business
• Ensures data from support services departments promote reliability and accuracy of information

Additional Duties and Qualities

• Is accountable for work performed, works to develop, and maintain trusting working relationships with others.
• Seeks to continuously learn from errors and experiences, as well as new developments in job specific areas.
• Performs other than normally assigned duties, as directed, and required, within and outside of the department to support Meritage’s business needs.
• Adopts, incorporates, is mindful of, and otherwise supports Meritage’s overarching annual and longer-term business goals and objectives while performing work duties, special projects and other duties as assigned within or outside of the Department.
• Consistently demonstrate behaviors, conduct and communications that support Meritage’s Practices and Values of Accountability, Diversity, Integrity and Respect for others, and seeks to influence these behaviors in others.

Continuously endeavors to “raise the bar” of performance and teamwork through a focus on Innovation, Collaboration, Equality and Compassion.

Go to application

---

Job Requirements

Requirements:

• A Bachelor’s degree in Accounting, Business or Finance (MBA or MS in a related field preferred).
• A minimum of 3 years current healthcare related financial planning and analysis work experience preferred.
• Strong knowledge of and experience with Microsoft Office, in particular Excel.
• Must have demonstrated analytical and problem-solving skills, designing and utilizing spreadsheets and graphs.
• Ability to handle shifting priorities and multiple projects independently with personal initiative is essential.

---

Apply Below

Job Description

Location: Fresno

Employment Status: Full Time

Position Summary

The Manager of Network Relations, Fresno Market is responsible for developing, maintaining and improving the Provider Network department principles, practices and procedures and producing timely and accurate Network data analytics and measures.  Presents departmental metrics and outcomes to management and physician groups as assigned.  Works with the Regional Director to build and expand the Provider Network in existing and new geographic areas within the Fresno/Madera Market.  Manages department workflow and outcomes to ensure departmental and organizational goals and objectives are met within established deadlines.  Supervises the Network Relations staff in their daily activities, as needed.  Represents the Network Relations Department with internal and external work groups and committees, as required.  Serves as the primary point of contact for the department with outside auditors, vendors, and/or practice issues that require troubleshooting and/or problem resolution.  Works cooperatively, collegially and frequently as a trusted partner with other Meritage managers for developing, maintaining and addressing intra-department workflow, collegiality, performance improvement and improved efficiencies.

Essential Job Responsibilities

1. Obtains, maintains and develops a thorough understanding of the Network Relations internal and external reporting requirements, including but not limited to metrics dashboards, State and Federal credentialing and licensing entities, and regular and ad hoc audits.
2. Performs general auditing, tracking and outcomes metrics using Microsoft Office applications (e.g., Excel), Power BI and other available software.
3. Works to maintain and develop strong effective working relationships with the Network physicians and their office staff, and with internal Meritage departments and leadership to ensure positive and collegial working relationships between Network Relations staff and co-workers in other departments. Is responsible for addressing and resolving any working relationship issues as they occur and will follow-up to ensure productive and respectful working relationships continue.
4. Will select, orient and train Network Relations department staff (Network Liaisons). Will communicate job expectations and continue to plan, monitor and appraise job results. Responsible for coaching, counseling and disciplinary action if needed.
5. Initially and on an ongoing periodic basis, spends time with each staff member to gain an understanding of their job duties, challenges, and to better identify and support process improvement initiatives.
6. Develops, audits and documents policies and procedures to strengthen department processes, policies and procedure and internal controls and workflow.
7. Analyzes work and develops new procedures to enhance workflow and improve efficiency while maintaining or enhancing accuracy within the department.
8. Attends, leads, and/or participates on assigned committees, work teams and organizational projects, as assigned. Will be responsible for preparing, reviewing and/or presenting information and materials, as well as scheduling meetings and taking minutes.
9. Participates in budget processes and prepares variance reports and analysis and uses department and company resources in a manner that demonstrates strong financial stewardship.
10. Provides excellent internal/external customer service, maintains a professional work attitude and approach, works well and in a positive manner with all other Meritage staff, and maintains strict confidentiality, in keeping with company policy, HIPAA and other applicable laws and regulations.
11. Demonstrates a commitment to ensuring department work and activities are complaint with state and federal laws and regulatory agency requirements as respects compliance; and, promptly investigates and addresses any alleged, perceived and/or real compliance infractions within the department.
12. Performs related work as required, special projects and other duties as assigned, within or outside of the Network Relations Department.
13. Works with direct reports to establish annual goals and objectives and coaches on the progress to enhance professional development of staff.
14. Actively participates and engages on the company’s Management Leadership Team (MLT) by partnering with other managers on cross-functional work efforts and projects, opening up lines of communication with other departments, providing periodic group training as required, attending monthly and ad hoc MLT meetings and events, and serving as an in-house subject matter expert for Network matters and questions.
15. Models professional work standards and behaviors to maintain and strengthen a professional working atmosphere and strictest confidentiality within the department and with other Meritage internal and external customers and work partners.
16. Is accountable for work performed by self and staff, works to develop and maintain trusting working relationships with others, and seeks to continuously learn from errors and experiences, as well as new developments in job specific Network Relations areas.
17. Adopts, incorporates, is mindful of, and otherwise supports Meritage’s overarching annual and longer-term strategic business goals and objectives while performing work duties, special projects and other duties as assigned within or outside of Accounting.
18. Consistently demonstrate behaviors, conduct and communications that support Meritage’s Practices and Values of Accountability, Diversity, Integrity and Respect for others, and will seek to influence these behaviors in others. Continuously endeavors to “raise the bar” of performance and teamwork through a focus on Innovation, Collaboration, Equality and

Go to application

---

Job Requirements

Education and Experience Requirements

Bachelor’s degree in Business, Health Care Administration or related field.

Minimum 6 years of current, professional, and hands-on related healthcare management work experience (managed care environment preferred), and previous progressively responsible Network development and provider contracting experience. Experience must include work involving relationship building with physicians and their office staff, and a strong customer service orientation.

Or, an equivalent combination of education, work experience, skills and knowledge.

---

Apply Below

Job Description

Location: Novato, CA

Employment Status: Full Time

Position Summary

The Human Resources Generalist performs a variety of Human Resources functions which include but are not limited to all aspects of Recruitment and on-boarding of new staff, Health & Welfare Benefits and Retirement Plan administration, and HRIS maintenance.  Also performs a variety of HR related employee recognition, relations, staff development and internal communications assignments and projects.  Works as part of a cohesive HR team, in close partnership with Meritage leadership who have open positions, and with the Accounting/Payroll department for issues associated with employee assignments, pay and benefits, and other job status/classification matters.  Works as an effective, collegial, and trusted partner to all Meritage staff, external partners (i.e. insurance carriers, brokers, advisors, etc.), and inter-disciplinary work teams.

Essential Job Duties

1. Assists the other members of the Human Resources team with daily workflow, operations, planning and prioritization of work, and project work associated with the department.
2. Supports the Chief Administrative Officer as required to support various HR and related functional area initiatives.
3. Responsible for employee recruitment activities for all level positions. This includes: clarifying content and requirements for open positions, updating Job Descriptions, posting jobs on the Meritage website and identified external posting and advertising sites, sourcing candidates (e.g. staff referrals, LinkedIn, etc.), screening applicants, forwarding candidates for management review, coordinating interview processes, obtaining references, assisting with negotiating employment offers, extending offers, and obtaining background screenings.
4. On-boards new employees, exits terminating employees, and tracks exit interview feedback and reports trends and findings as required.
5. Responsible for intake, response to and follow-up of EDD data requests for employees accessing SDI benefits and following termination of employment.
6. Responsible for organizing and maintaining applicant databases, tracks status of openings, and develops, tracks and reports recruitment and hiring metrics.
7. Understands and communicates company benefits programs, including Retirement Plan, and company mission and values.
8. Assists with the planning, development and drafting of materials and processes associated with annual Benefits Open Enrollment. Assists with annual benefits fairs by working closely with HR team members, health plan brokers and benefits carriers.
9. Assists with the coordination and tracking of all aspects of staff Leaves of Absences, consistent with FMLA, CFRA, ADA, and all other regulatory laws, rules, and requirements.
10. Utilizes the company HRIS and assists with input and regular audit of employee data – demographics, assignment, and benefits data. Maintains excellent working knowledge of the HRIS and continues to develop more advanced skills in this area.
11. Updates employee electronic files and databases to document personnel actions and to provide information for payroll and other uses.
12. Works closely with and acts as primary back up for the Senior HR Generalist and assumes assigned duties in their absence.
13. Is accountable for work performed, works to develop, and maintain trusting working relationships with Meritage staff, HR co-workers, leadership, and external business partners.
14. Seeks to continuously learn from errors and experiences, as well as new developments in job specific HR areas, and actively applies continuous performance improvement methods to workflows and processes.
15. Performs other than normally assigned duties, as required, within and outside of the HR department to support Meritage’s business needs.
16. Adopts, incorporates, is mindful of, and otherwise supports Meritage’s overarching annual and longer-term business goals and objectives while performing regular job responsibilities, special projects and other duties as assigned.
17. Consistently demonstrate behaviors, conduct and communications that support Meritage’s Practices and Values of Accountability, Diversity, Integrity and Respect for others, and seeks to influence these behaviors in others.
18. Continuously endeavors to “raise the bar” of performance and teamwork through a focus on Innovation, Collaboration, Equality and
19. Initially and on an ongoing periodic basis, spends time with each HR staff member, payroll and other identified internal staff to gain an understanding of their job duties, challenges, and to better identify and support an effective continuum of workflow with Meritage, to support continuous process improvement and remove any roadblocks impacting productivity.

Go to application

---

Job Requirements

Minimum Requirements:

1. A Bachelor’s Degree in Human Resources or related field.
2. A minimum of 2-3 years of current directly related HR experience, preferably in Healthcare.
3. Or, an equivalent combination of education, work experience, and skills (see below).
4. HR Certification is preferred

Knowledge and Skills:

• Strong working knowledge of updating, maintaining, auditing, and developing an HRIS system, including  reporting capabilities for report generation.
• Current understanding of State and Federal laws and regulations related to fair and lawful interviewing and hiring processes, Section 125 Health and Welfare plans, Leaves of Absence, 401(k) retirement plans, At-Will employment arrangements and related progressive disciplinary actions and processes, and termination actions.
• Strong skills and working experience with Excel, PowerPoint, Publisher, and Word.
• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratios, and percentages.
• Excellent written, verbal and listening communication skills, with the ability to conduct presentations over Microsoft Teams, Zoom and in person.
• Professional demeanor with a positive and self-confident, yet approachable and kind, affect.
• Ability to exercise cognitive thinking skills and to work independently with minimal supervision.
• Ability to develop, draft, update and communicate policies and procedures.
• Demonstrated ability to work in a fast-paced environment with rapidly changing and competing priorities.
• Take initiative and determines best course of action for a vast array of HR issues by accessing all available resources.

---

Apply Below

Job Description

Location: California-remote

Employment Status: Full Time

The Claims Auditor is responsible for auditing adjudicated claims for accuracy of payments and denials. Knowledge of all claims procedures, claim types (facility, professional, ancillary), different pricing methodology are essential. Ensure claims compliance in all areas. Prepares and maintains audit reports.

Key Responsibilities

• Conducts audit and quality control of adjudicated claims for accuracy in amount paid/denied, appropriate use of claim adjustment codes, payment explanation, correct provider and vendor selection.
• Follows established policies and procedures and use available resources such as provider contracts, Medi-Cal and Member Evidence of Coverage (EOC) to process, and adjust routine assigned claims in an accurate and timely manner.
• Identifies root cause of errors such as processing or claims system configuration Prepares and submits audit reports which include audit findings, scores and corrective actions.
• Monitors completion of corrective actions
• Provides timely feedback to management.
• Maintains a current working knowledge of all claims regulatory requirements for Medicare and Medi-Cal claims
• Conducts training as necessary.
• Assists in the reconciliation and review of claims related issues.
• Collaborates with peers, staff in other departments vendors, and Management to improve processes and department work quality
• Attends and actively participates in daily, weekly, and monthly departmental meetings, training and coaching sessions.
• Organizes and maintain all audit files
• Other related duties as assigned.

 

Go to application

---

Job Requirements

• High school diploma or equivalent.
• College degree preferred
• A minimum of five years of Medi-Cal and Medicare claims processing experience and/or combine of education and experience
• Knowledge of medical terminology, ICD-9/ICD-10, CPT and DRG coding, required.
• A minimum of two years experience in a managed care organization, preferred.
• Excellent knowledge of claims systems.
• Ability to demonstrate organizational skills with a high attention to detail as well as strong verbal and written communication skills.
• Ability to maintain designated production and quality standards.
• Knowledge of different providers’ payment methodologies (i.e., capitation, fee for service based on RBRVS, Medicaid and other negotiated flat rates, RVS pricing, Per Diem, DRG pricing, etc.), preferred.
• Ability to deal with complex claim issues.
• Knowledge of Medicare and Medicaid claims processing guidelines, Title 28 Claims Settlement Practices and other regulatory requirements.
• Proficient with Microsoft Office programs including PowerPoint, Outlook, Word, Excel and common computer equipment and office hardware.
• Strong analytical skills
• Ability to calculate audit scores using different formulas
• Ability to complete tasks in a timely manner.
• Ability to communicate effectively both verbally and in writing.
• Ability to work in a fast pace environment with minimal supervision

---

Apply Below

Job Description

Location: Novato, CA

Employment Status: Full Time

Position Summary:

The Utilization Management (UM) Nurse is responsible for general, preauthorization and/or retrospective review of outpatient services and for the determination of medical appropriateness and medical necessity for a variety of services using evidence-based clinical guidelines and works with providers to meet the health care needs of members with the appropriate resources.

• Performs prior authorization and retrospective review according to evidence-based clinical criteria, Medicare Guidelines, and established protocols to determine the medical appropriateness of the request.
• Refers cases to the Medical Director, Utilization Management when the treatment request does not meet medical necessity guidelines or when peer-to-peer conversation is necessary.
• Makes referrals to the Medical Director, Utilization Management in a timely manner, to allow time to make appropriate contact with the requesting provider is accordance with State, Federal, Regulatory, and accreditation turnaround times.
• Maintains a thorough understanding of NCQA, URAC, and CMS guidelines for Utilization Management.
• Communicates with members of the Utilization and Care Management team, reviews medical records, uses clinical expertise, and compares information to established guidelines and the member’s benefit plan.

Go to application

---

Job Requirements

Required Qualifications:

1. Ability to be a team player and exercise initiative in responding to provider requests and concerns in a helpful and courteous manner
2. Provider contracting and customer service techniques
3. General understanding of the health care industry, ideally the provider relations field-desired
4. Excellent interpersonal and telephone communication skills are required
5. Exercise attention to detail; ability to provide accurate data entry
6. Ability to work under pressure with minimal supervision, multi-task, complete projects in a timely fashion and meet deadlines a must
7. Excellent analytical, problem solving and organizational skills a must.
8. Language Skills: Strong communication skills both written and verbal to work with multiple internal and external clients
9. Mathematical Skills: Ability to work with mathematical concepts such as probability and statistical inference. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations
10. Reasoning Ability: Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems.
11. Computer Skills: Ability to create and maintain documents using Microsoft Office (Word, Excel, Outlook, PowerPoint)

Minimum Experience

• 3+ years of experience clinical experience in an acute care facility or equivalent combination of education and experience
• 3 years experience working in Managed Care. Medicare experience preferred.
• Payor experience and/or experience with nationally recognized clinical criteria, including MCG

Education/Licensure:

• Graduate of an approved nursing program
• A current, unrestricted California RN  license

---

Apply Below