Job Description

Location: Novato, CA

Employment Status: Exempt

Position Summary

The Manager of Risk Adjustment is responsible for managing a team of professionals to meet the needs of the Medicare and Commercial lines of business, as related risk adjustment issues.  The Manager will work in collaboration with other business leaders, and clinical leadership, within and outside of Meritage and Babylon Health (parent company), to develop and implement comprehensive strategies to manage and drive improvement in end-to-end clinical documentation process, from on-boarding to claims submission and reporting. The Manager will work closely with the RAF (Risk Adjustment Factor) Supervisor for management of department staff and other resources. A primary focus will involve working the with VP of Clinical Programs, the Chief Medical Officer and other members of leadership to develop, implement, track and refine Babylon Health’s Risk Adjustment operations for Meritage, First Choice Medical Group (FCMG) and other IPA’s outside of California. This will involve building relationships, conducting cost benefit analysis and developing plans to implement and carry out business and operational strategies for new business arrangements.

Principle Accountabilities

• Manage all risk adjustment activities, including developing process flows, establishing, tracking, and meeting deadlines, managing vendor execution within contract requirements, coordinating all submission and reconciliation with internal and external stakeholders.
• Lead Risk Adjustment Work Groups and deliverables in collaboration with Medical Director.
• Create work plans and timelines for projects and manage risk adjustment supervisor, providing relevant training and delegation of new projects as needed to achieve team goals.
• Guide process improvement efforts around coding, claims process and overall revenue cycle management.
• Track overall portfolio of projects/initiatives and integration with other key functional teams’ work plans.
• Evaluate the risk adjustment strategy and submission processes of clients to identify improvement opportunities.
• Provide support and guidance on risk adjustment and clinical quality operations, accreditation, quality improvement initiatives.
• Support root cause analysis and develop targeted interventions designed to improve clinical quality and risk adjustment outcomes.
• Work with Financial Planning and Analysis to track and evaluate the impact of initiatives and programs.
• Manage vendor relationships to support coding, claims processing, billing and collections efforts.
• Leads audit strategies of delegated parties and in plan’s regulatory risk adjustment data validation audits.
• Model and trend RAF and risk adjusted revenue and utilization costs by PMPM by plan and line of business to determine and make recommendations on overall revenue cycle impacts on an at least quarterly basis.
• Calculate ROI on all vendor programs and make recommendations on contract continuation and negotiation.
• Analyze impact of new implementations on department and reallocate staff duties as necessary.
• Drives change initiatives to address future-oriented business needs.
• Identifies process and infrastructures needed to support change and considers broad range of internal/external factors when making decisions.
• Provides excellent internal/external customer service while maintaining a professional working attitude, approach and demeanor.
• Models professional standards to staff and others, ensuring strict confidentiality of all business and Risk Adjustment specific related data, files, records and information.
• Is knowledgeable of and ensures department and staff adherence with all applicable HIPAA, Privacy, Fraud Waste and Abuse, and other compliance laws, regulations and requirements that apply to a healthcare operation.
• Works with direct reports to establish department specific annual goals and objectives, and employee satisfactions strategies, and tracks and reports on progress towards meeting identified department goals and efforts.
• 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/ cross-training, regularly attending scheduled and ad hoc MLT meetings and events, and serving as an in-house subject matter expert for Risk Adjustment matters and questions.
• Assesses, develops, drafts, documents, disseminates, and implements policies and procedures to maintain and strengthen department processes, efficiencies, accuracy, compliance, and internal controls. Tracks effectiveness and applicability of said policies and procedures.
• Conducts other risk-adjustment department financial, workflow and volume related analysis to support company and management objectives and decision-making.
• 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.
• 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 administration and operational areas.
• Performs other than normally assigned duties and projects, as directed and required, within and outside of the department to support Meritage’s overall business needs, goals and objectives.
• 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 home department. Keeps staff informed of company business goals and objectives.
• 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.

Job Requirements

Qualifications and Requirements

• Bachelor’s degree in business, health administration, health policy, finance or a related field is required. Master’s degree preferred.
• 3-5 years of recent work experience in Medicare and Commercial  Risk Adjustment.
• 2+ years of people management experience required.
• Experience working multiple concurrent projects.
• Demonstrates strong analytical and decision-making skills.
• Demonstrated success in independently planning and managing multiple projects and reevaluating priorities in a self-directed manner and meeting challenging deadlines, and be willing to work long and flexible hours during peak project times to get the job done.
• Certified Risk Adjustment Coder (CRC).
• Risk adjustment experience across multiple product lines (i.e., Medicare, Medicaid, ACA).
• Quality expertise (HEDIS, NCQA Accreditation, Star Ratings).

Knowledge

• Demonstrated knowledge in leadership, collaboration, and performance/process improvement.
• Demonstrated knowledge in Risk Adjustment, HCC coding, annual wellness examination requirements, Medicare documentation standard, PMPM analytics.

Skills

• Ability to work in a positive, respectful and productive manner with all levels of staff, physicians, and leadership within Meritage Medical Network.
• Positive and productive working relationships within and outside of Meritage Medical Network.
• Excellent written, verbal, and presentation and communications skills.
• Demonstrated leadership in clinical and business operations.
• Ability to build consensus.
• A strong working commitment to integrity and accountability.
• Projects a confident and professional demeanor.
• Adapts personal leadership style to different situation and different people.
• Maintains strategic perspective of broader impact beyond own team.
• Inspires engagement and active participation of appropriate stakeholders.
• Strong computer skills (Various EHRs, Platforms, Microsoft excel, publisher, pdf, word).

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Job Description

Location: Novato, CA (onsite)

Employment Status: Full-time

General Statement of Duties

The IT Support Specialist covers planning and delivery of customer support services including installation, troubleshooting, user assistance, and training. Functions may include diagnosing and resolving problems in response to customer reported incidents, planning and analysis of work processes, researching and reporting trends and patterns of problems, developing training materials and performing computing/information system training sessions, developing and maintaining problem tracking databases, installing, troubleshooting, and maintaining hardware and software, performing backup and recovery operations, consulting with users to identify needs and requirements, conducting feasibility studies and trade-off analyses, preparing business cases, and ensuring the rigorous application of information security/information assurance policies, principles, and practices.

Duties and Responsibilities

• Oversees, maintains and troubleshoots local area networks; Performs preventative maintenance in accordance with department
• Installs applications software on the networks; maintains network
• Creates and maintains users, directory structures, security rights and printer
• Discusses software applications with users to determine level of satisfaction and/or the need to modify software.
• Trouble shoots technical problems; notifies appropriate technology staff of software failures and provides computer
• Maintains database of inventory of workstations and associated equipment; assists in research and purchase of hardware and
• Recommends reallocation of operating staff and equipment resources to meet network
• Provides technical advice and assistance to users concerning data communication equipment and data transmission.
• Oversees electronic e-mail/fax
• Train administrative and clerical staff on basic computer usage and office applications software such as Adobe, Office 365, UCx Softphone.
• Research and evaluate new technologies and attend training sessions and seminars to further
• May be responsible for developing and/or maintaining the public and private website.

Job Requirements

Minimum Requirements

Education:

• A bachelor’s degree in computer science and 2-3 years of related work experience or an equivalent combination of education and work experience.
• Possession of a Network Administration Certificate is preferred.

Training and Experience:

• Experience in all areas of local and wide area networks management and administration including system configuration, setup, troubleshooting, planning, designing, implementation, and user support; experience installing and supporting Microsoft server technologies; experience supporting telecommunications equipment.
• Thorough knowledge of the operation and use of personal computers and their peripheral equipment Good knowledge of logical operation of computers and data communication devices.
• Working knowledge of networking computers.
• Working knowledge of data processing methodology and techniques in creating documentation and data security.
• Knowledge of Windows and OSX operating systems.

Skills and Abilities:

• Conduct research into a wide range of computing issues as required.
• Simply technical terminology for training purposes.
• Identify and resolve user problems.
• Communicate effectively both orally and in writing.
• Plan, organize, and prioritize work assignments.
• Establish and maintain effective working relationships.
• Dealing with customers that may be upset or confrontational.
• Contribute effectively to the accomplishment of team goals, objectives and activities.
• Working without close supervision in standard work situations.

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Job Description

Location: Novato, CA (remote)

Employment Status: Full-time

Duties & Responsibilities:

• Prepare relevant data analyses and reporting that helps departments meet their objectives and support 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.

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 the 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 timelines.

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

• 2+ years of data analysis experience
• (Preferred) Experience 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 , California

Employment Status: Full-Time

General Statement of Duties

Prepare relevant data analyses and reporting that helps the Quality department meet their objectives and support the business initiatives of the organization.

Duties and Responsibilities

• Prepare relevant data analyses and reporting that helps the Quality department meet their objectives and support 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 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.
• Conduct ad-hoc analyses of performance data per Medical Group requirements.
• Assist with the annual quality audit for the Align Measure Perform program.
• Assist with internal and external quality audits to ensure accurate data is being sent and received following compliance standards.
• Receive and file all health plan quality reports and member gap lists.
• Combine Quality target lists for outreach efforts.
• Create and maintain Excel trackers for outreach efforts.
• Track status of incentive payments.

Job Requirements

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 the content.
• Excellent written and verbal communication skills, including designing and presenting reports to internal and external groups.
• Critical thinking and independent problem resolution skills.
• Ability to prioritize workload to meet deadlines for short and long-term goals with competing timelines.

 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, Teams, etc.
• Proficiency with or the ability to learn to use project management and collaboration software: Asana, SharePoint.
• Experience working in EMR systems.

 Education and Experience

• Ideally, 2+ years of data analysis experience.
• Ideally, a background in the following areas: ACOs, Health Plans (Medicare and Medicaid), HEDIS, Align Measure Perform (AMP), 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, CA

Employment Status: Full-time

Position Summary

The Care Management Administrative Support Supervisor designation carries additional duties and responsibilities that overlay a senior lead staff member’s regular job responsibilities in a functional area when its determined that the area needs greater on-site supervision of staff and operational oversight than is previously been provided to a work team. The Supervisor  is also responsible for the following:  Coordinate, schedule, and arrange internal and provider meetings as needed, including reserving locations, coordinating, and disseminating handouts and other printed/electronic meeting materials for Department Manager, the Risk Adjustment Medical Director, and the UR medical director. The Supervisor engages in leadership and first line management responsibilities on average, greater than 50% of the time. 

Department administrative duties:

• Maintain meeting minutes and records.
• Work with the director of care management to plan and schedule staff meetings.
• Mailings and data entry for special projects.
• Appeals- work with the Utilization Review care management team to complete appeals.
• Grievances- work with the director of care management and senior medical director to review and track grievances for quality reporting.
• Assist any member of the Care Management department staff as needed.

Principal Accountabilities:

• Respects patients by recognizing their rights; maintaining the confidentiality.
• Treats all patients with dignity and respect.
• Contributes to the team effort by accomplishing delegated tasks on time.
• Understanding of different divisions under the care management department.
• Administrative duties as assigned.
• Understanding of completion of appeals and grievances.
• Additional supervisory duties according to Supervisory Role Designation.

Job Requirements

Qualifications:

• Bachelor’s degree in healthcare-related field preferred, or equivalent combination of healthcare-related work experience and education.
• 1 year of customer service experience in a front or back medical office/organization environment preferred.
• 1 year of patient care experience, Medicare or other senior patients’ population preferred.

Skills and Requirements:

• Highly organized with proven effectiveness in time management.
• Skilled in the use of computers and multiple software systems.
• Detail-oriented and systems-thinking.
• Clinical knowledge like medical terminology, and experience with electronic health records.
• Excellent team communication skills.
• Ability to follow through with tasks as assigned.
• Work experience in a health care setting is preferred.
• Bachelor’s Degree in a health-related field is a plus.

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Job Description

Location: Novato, CA

Employment Status: Full-time

Position Summary

The UM Administrative Support Supervisor designation carries additional duties and responsibilities that overlay a senior lead staff member’s regular job responsibilities in a functional area when its determined that the area needs greater on-site supervision of staff and operational oversight than is previously been provided to a work team The UM Administrative Support Supervisor serves as a liaison between Meritage Medical Network, our contracted health plans, Network physicians and Members. The incumbent is responsible for intake of all requests for medical services. Must have the ability to understand and use set criteria and approve specific services within the related UM system. The Supervisor engages in leadership and first-line management responsibilities on average, greater than 50% of the time.

Primary Responsibilities:

• Ensure prompt, accurate data entry of Authorization requests into the MedVision system.
• Utilize knowledge and experience to analyze contractual or administrative issues related to the request.
• 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.
• 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
• Additional supervisory duties according to Supervisor Role Designation.

Job Requirements

Qualifications:

• LVN or Graduate of Medical Assistant program preferred.
• 1 – 2 years of related experience.
• Familiarity with Medical terminology required.
• Familiarity with insurance billing and terminology preferred.
• Managed Care experience, preferred.
• Knowledge of CPT and ICD codes.
• Strong data entry skills.
• 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 Excel, Outlook and other Microsoft Office applications.
• Must be organized and detail-oriented.

Education:

• High School Diploma required.
• Medical Terminology, coding.

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Job Description

Location: Novato, CA

Employment Status: Full-time

General Summary

The UM RN Supervisor designation carries additional duties and responsibilities that overlay a senior lead staff member’s regular job responsibilities in a functional area when it’s determined that the area needs greater on-site supervision of staff and operational oversight then is previously been provided to a work team. This position is responsible for analyzing clinical information submitted by medical providers by evaluating the medical necessity, appropriateness and efficiency of the medical services, procedures and facilities use for commercial and Medicare members. The supervisor serves as an expert daily resource to assigned department staff and other internal and external customers, vendors and company business partners. The supervisor is the established “go to” person to assist others with questions, guidance, training, and support with technical, administrative and customer service aspects of the department. Evaluations are completed using evidence-based guidelines created for non-physician clinicians establishing medical necessity.  These duties may include assignments to all venues requiring utilization management such as pre-authorization for inpatient and outpatient services, concurrent inpatient and observation hospital stays, Skilled Nursing Facility (SNF) stays, ambulatory services and other services as required.  This job may coordinate utilization management and case management activities.  The Utilization Management nurse is knowledgeable about the CA Nurse Practice Act, NCQA, MCG (Milliman Care Guidelines), the Center for Medicare and Medicaid, DMHC and timeliness rules and pertinent state and federal regulations. The Supervisor engages in leadership and first line management responsibilities on average, greater than 50% of the time.

Principle Accountabilities

• Review routine and urgent requests for service authorization on assigned patients in accordance with NCQA timeliness standards and health plan benefit structure.
• Prepares and presents cases for UM Medical Director review in a concise, objective and organized manner.
• Educates and supports members in accessing care using their HMO and Medicare Advantage benefits as indicated.
• Identifies and refers patients to disease management, wellness programs and community resources whenever relevant.
• Utilizes the nursing process and critical thinking skills to provide oversight of services and evaluation of service options.
• Additional supervisory duties according to Supervisor Role Designation.

Job Requirements

Minimum Requirements

Education:          

• Completion of Diploma or Associates Degree in Nursing.
• Bachelor’s Degree in the Science of Nursing Preferred.

Experience:   

• Minimum three to five years of clinical experience.

• Minimum one to three years in a managed care or health plan environment.

Licensure:

• Current and unrestricted License from the California Board of Nursing.

Knowledge, Skills, and Competencies

• Ability to understand and facilitate communication among team members, patients, families, physicians and medical office staff.
• Ability to communicate effectively with contracted health plans and meet required turn around times.
• Excellent clinical judgment, critical thinking skills and independent problem resolution.
• Knowledge of managed care principles, HMO and Risk contracting arrangements.
• Ability to organize and prioritize workload.
• Proficient typing skills with competency in working with Microsoft Word, Excel, Outlook, varied EMR platforms.  Prior experience with Health Care Management/authorization software preferred.
• Excellent telephonic customer service skills.
• Flexibility to learn and work in various RN assignment within the department.
• Ability to work with and provide sensitivity to a variety of culturally diverse communities.

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Job Description

Location: Novato, CA - Remote

Employment Status: Non-Exempt

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 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.

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:

• High School diploma or equivalent.
• CPC certification required. CRC certification preferred.
• 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.
• Working knowledge in Risk Adjustment or HCC coding.
• Experience with Direct Contracting Entity (DCE) or Accountable Care Organization (ACO).

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Job Description

Location: Novato , California

Employment Status: Full-Time

Position Summary:

The Care Management Department Coordinator (DCE)  is responsible for the following:

Coordinate, schedule, and arrange internal and provider meetings as needed, including reserving locations, coordinating, and disseminating handouts and other printed/electronic meeting materials for Department Manager, the Risk Adjustment Medical Director, and the UR medical director.

 Department administrative duties:

• Maintain meeting minutes and records.
• Work with the director of care management to plan and schedule staff meetings
• Mailings and data entry for special projects.
• Appeals- work with the Utilization Review care management team to complete appeals.
• Grievances- work with the director of care management and senior medical director to review and track grievances for quality reporting.
• Assist any member of the Care Management department staff as needed.

Principal Accountabilities:

• Respects patients by recognizing their rights; maintaining confidentiality.
• Treats all patients with dignity and respect.
• Contributes to the team effort by accomplishing delegated tasks on time.
• Understanding of different divisions under the care management department.
• Administrative duties as assigned.
• Understanding of completion of appeals and grievances.

Qualifications:

• Bachelor’s degree in healthcare-related field preferred, or equivalent combination of healthcare-related work experience and education.
• 1 year of customer service experience in a front or back medical office/organization environment preferred.
• 1 year of patient care experience, Medicare or other senior patients’ population preferred.
• Direct Contracting Entity (DCE) and/or Accountable Care Organization (ACO) experience preferred.

Job Requirements

 Skills and Requirements:

• Highly organized with proven effectiveness at time management.
• Skilled in the use of computers and multiple software systems.
• Detail-oriented and systems-thinking.
• Clinical knowledge like medical terminology, and experience with electronic health records.
• Excellent team communication skills.
• Ability to follow through with tasks as assigned.
• Work experience in a health care setting is preferred.
• Bachelor’s Degree in a health-related field is a plus.

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Job Description

Location: Novato , California

Employment Status: Full-Time

General Summary: The Care Management RN (DCE) manages defined populations by using a collaborative process of assessment, planning, implementation, and evaluation, to engage, educate, and promote/influence beneficiary decisions related to achieving and maintaining optimal health status in the Outpatient setting. The Care Management RN (DCE) uses a combination of proactive telephone calls, hospital, MD office, and home visits to beneficiaries who are enrolled in Meritage’s medical and wellness programs. This position is responsible for developing and maintaining ongoing supportive relationships with all members of the Care Management Team and beneficiaries.

Principal Accountabilities:

• Reaches out to patients identified as appropriate to provide information and education in order to deepen their understanding of their medical condition and to guide the patient in self-management of the chronic
• Emphasizes the value of health education and behavior
• Participates in all aspects of the Care Transitions
• Actively participates in the Care Team to improve/maintain positive healthcare outcomes and care
• Works in collaboration with the individual patient and his/her attending
• Supports the Primary Care Physicians and their office
• Applies the standard elements of assessment, planning, implementation, coordination, monitoring, and evaluation and will use state-of-art information
• Is highly organized, effective at managing her/his time, and is skilled in the use of computers and multiple software
• Remains objective in relationships with patients, families, and physicians and promotes a team approach by encouraging communication among all members of the care
• Coordinates care among multiple treating physicians including specialists, primary care, hospitalists, and behavioral health care, as needed
• Performs other clinical and related administrative duties as assigned to support the organization’s operational needs.

Job Requirements

Qualifications:

• Current California RN License with no restrictions
• 5 years clinical experience, previous case/care management experience preferred
• Strong working knowledge of Electronic Health Records, Microsoft Office Suite including Excel, Outlook, Teams
• BSN preferred
• Coleman model trained is a plus.
• Direct Contracting Entity (DCE) and Accountable Care Organization (ACO) experience desired.

Requirements:

• Familiarity with data collection and methods of analyzing and reporting data, metrics, and related information pertaining to clinical health
• Professional written and verbal communication
• Ability to function effectively in a team with patients, families, physicians, MD office, and other Meritage departments and
• Treats others in a respectful, kind, and patient
• Demonstrates sound clinical judgment and critical thinking in accordance with the California Nurse Practice
• Self-motivated, able to ask for assistance, and adapts easily to
• Has a strong sense of accountability for work performed and in meeting
• Knowledgeable about the available health care and community resources for the populations
• Understanding of family dynamics and the influence of cultural and spiritual values in health care.
• Current valid driver’s license and reliable transportation with the required level of automobile liability insurance coverage.

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Job Description

Location: Novato , California

Employment Status: Full-Time

The Network Relations Supervisor is a working supervisor and performs and supervises staff who perform a wide range of administrative support functions within the Network Relations Department, with a strong focus on development and tracking of department metrics, performance indicators, and database maintenance, including initial set-up and entry of data elements, data imports, and the ongoing maintenance and regular auditing of information maintained in multiple systems.  Ensures Network and Provider lists, rosters, fee schedules, contract templates, and related records and documents are current, accurate, and otherwise continuously maintained. Accountable for the integrity and quality of data maintained and works to resolve discrepancies through collaboration with staff, colleagues, and customers within and outside of the Network Relations department.  Supervisor work is greater than 50% of this position’s job scope (see attached Supervisor responsibilities that supplement this Job Description).

SUMMARY OF RESPONSIBILITIES

• Responsible for ensuring network updates such as Adds/Terms/Changes related to demographic and contract conversions via a work queue assignment and maintained.
• Audits and tests demographic and/or fee schedule imports based on work queue assignment.
• Researches and resolves issues regarding provider data, fee schedules, configuration, originating from various departments, and conversion audits.
• Ensures ongoing database cleanup through various reports, research and outreach via email and phone calls.
• Responsible for the maintenance and verification of physician rosters, and roster reconciliations.
• Ensures prompt and accurate data entry into various departmental systems, databases, and company systems, Quick Cap C7, including tasks in the queue.
• Maintains organization of files on departmental shared drives, assigned systems, and databases to ensure such information is up-to-date and easily accessible.
• Ensures department productivity, efficiency, and performance metrics, goals, and objectives are met.
• Identifies process, practice, and procedural changes and improvement to streamline, simplify and strengthen department efficiencies in assigned areas.
• Contributes to the efficiency of the department by being cross-trained and ensuring direct reporting staff is cross-trained on other functions.
• Responsible for gathering, coordinating, and reporting Network department data, including reports to health plans, regulatory agencies, Network Providers, and other internal and external parties.

• Is accountable for work performed, works to develop, and maintains trusting working relationships with Meritage staff, co-workers, leadership, and external business partners, e.g. Health Plan and physician office representatives.
• Seeks to continuously learn from errors and experiences, as well as new developments in job-specific

areas, and actively apply continuous performance improvement methods to workflows and processes.

• Performs other than normally assigned duties, as required, within and outside of the home 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 regular job responsibilities, special projects, and other duties as assigned.
• 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
• Initially and on an ongoing periodic basis, spends time with (i.e. “shadows”), staff in other departments to gain an understanding of their job duties, challenges, and to better identify and support an effective continuum of workflow within Meritage, and remove any roadblocks impacting productivity.

Key Competencies

Knowledge of MS Office and related applications.

• Demonstrates the ability to learn and utilize Quick Cap proprietary systems.
• Manage data received in various formats from various sources
• Processes provider updates efficiently and accurately
• Proficient knowledge of MS Access and Excel.
• Proficient knowledge of relational databases.
• Familiar with provider data elements, provider contracts, claims logic, and provider matching.
• Managed Care experience preferred but not required

Job Requirements

SUMMARY OF QUALIFICATIONS

• Bachelor’s Degree with 3 years of related experience, including supervisory, and/or training or equivalent combination of education and experience
• Demonstrated leadership skills with the ability to effectively oversee the work of staff.
• Strong detail orientation and organizational skills.
• Effective written, verbal, and listening communication skills.
• Ability to learn and utilize company systems, i.e., Quick Cap
• Proficient with MS Office (Word and Excel), Outlook and Internet, FTP sites, and downloading of files.

WORK ENVIRONMENT

• Self-motivated and able to work independently and as part of a team, but also to know when to ask for help from co-workers and supervisors.
• Required to handle and balance multiple priorities from various service areas.
• Fast-paced work environment.
• Able to solve problems and take initiative.

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Job Description

Location: Novato, CA

Employment Status: Full-time

Job Summary:

The Executive Assistant (EA) assists and supports multiple members of the senior leadership team for Meritage and coordinates work and efforts with the Executive Assistant to the CEO, who also support other assigned senior executives.  Responsible for handling a wide variety of situations involving administrative functions of the assigned executive offices, including but not limited to scheduling and coordinating senior level meetings, calendars, travel, events, projects, correspondence, and communications.  Develops and prepares presentations and reports. Ensures effective and expedient interactions and coordination of efforts among and between the senior leadership team and other internal departments and external business associates and vendors, including Babylon Health and Prima Medical Group.  The EA represents the Meritage senior leadership team within the company, with external parties, business partners, vendors and community representatives, and coordinates activities in the administration office.  Exercises professional judgement and discretion in carrying out all duties.

Duties:

• Organizes regular standing and ad hoc business meetings and events, ensuring proper planning and coordination of venues, meals, equipment, materials, and other necessary resources.
• Maintains the meeting schedule for assigned committees and work teams and prepares and distributes agendas, supporting materials, and minutes in advance of all meetings.
• Serves as staff to all regular standing business meetings, assigned Committees, and related meetings, and records and maintains all meeting minutes, records, files and related materials.
• Composes and prepares internal and external correspondence, communications, presentations, and other materials/documents for assigned executives’ approval and/or signature.
• Makes travel arrangements for individuals and groups of people.
• Establishes, organizes, and maintains records, files and documents related to the offices assigned executives.
• Provides administrative assistance for all functions related to the offices of assigned senior leadership within the Meritage organization.
• Makes certain that sensitive information and material are maintained in a strictly confidential manner.
• Exercise’s sound professional judgement and discretion in receiving and distributing information for assigned executives.
• Collaborate with and maintain open communication with all departments within Meritage Medical Network to ensure effective and efficient workflow and to facilitate completion of tasks and goals.
• 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.
• 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.
• Is accountable for work performed by self, 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 administration and operational areas.
• 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 Performance Improvement.
• Performs other than normally assigned duties and projects, as directed, and required, within and outside of Performance Improvement to support Meritage’s overall business needs, goals, and objectives

Job Requirements

Qualifications and Requirements:

• Bachelor’s degree in and applicable field (e.g., English, Business, etc.), and five years of directly related healthcare work experience; or equivalent combination of education and work experience.
• Excellent working knowledge of Microsoft Office Suite applications: Word, Excel, PowerPoint, Outlook, Teams, etc.
• Excellent organization, problems-solving and time management skills.
• Excellent interpersonal skills and professional demeanor, with the ability to avoid and extinguish gossip and speculation of and with other staff.
• Excellent written, verbal and active listening skills.
• Experience handling highly sensitive and confidential information and material.
• Ability to adapt and excel in a fast-pace work environment and juggle multiple high priority assignment at the same time.

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Job Description

Location: Novato, CA

Employment Status: Full-time

Position Summary:

This position reports through the Business Services division at Meritage and supports and manages the implementation of assigned projects for the entire organization.  Functions as a focal point for the evaluation and implementation of projects, initiatives and efforts that span all or multiple departments within Meritage.  May handle multiple ongoing projects at a time and serves as the primary client/customer contact for assigned projects.  Responsible for assembling the project work teams with internal stakeholders and relevant external business partners/vendors.  Shepherds the work of team members for the duration of the implementation process through “go live”.  Reports on the status of projects underway, manages the project change process, manages internal and external customer expectations, escalates issues as appropriate, and identifies opportunities for follow-up or new projects.  Works to resolves issues that impact timing and successful implementation.

Job Requirements

Duties:

• Develops project timelines, including short and long-term plans, key milestones, assignment of duties to each project plan work team member, and project “go-live” dates.
• Utilizes recommended and supported processes, standards, and tools to manage projects from inception through implementation to post implementation review and service transition.
• Ensures that projects are well planned, maintained, and communicated.
• Manages and is accountable for funded projects to ensure projects are completed within budgetary guidelines.
• Escalates issues that impact timing or budget to management and works with members of the project team to solicit additional team resources as needed during the project lifecycle
• Assembles project plan work team members from key stakeholder departments, and general support departments (e.g., IT, Finance, HR, etc.), assigns and delegates assignments to team members, and works to develop a team focused collaborative work environment of shared and individually assigned accountability.
• Evaluates and plans for all new projects from a lens of performance improvement and greater efficiencies.
• Adjusts schedules and targets on projects as needs, priorities, objectives, and/or financing changes.
• Performs quality control on projects throughout development to maintain the standards expected.
• Partners with project work team and non-work team clients/customers, technical staff, and management to effect successful projects and effective re-engineering of existing processes to support greater efficiencies and new initiatives.
• Provides, facilitates timely and effective transition of completed projects to client department staff for the ongoing administration of projects and initiatives.
• 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
• 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.
• Is accountable for work performed by self, 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 administration and operational areas.
• 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 Performance Improvement.
• Performs other than normally assigned duties and projects, as directed, and required, within and outside of Performance Improvement to support Meritage’s overall business needs, goals, and objectives.

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Job Description

Location: Novato, CA

Employment Status: Full Time

As a key member of the Network Relations Department, this position serves as a liaison for assigned geographic regions between Meritage and networked physician 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 physician 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.

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.

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Job Description

Location: Novato, CA (onsite)

Employment Status: Full-time

General Summary

The HR Coordinator will assist in the day-to-day operations and provide comprehensive support to the daily operation of the Human Resources department, and the HR Business Partners in areas including, but not limited to, employee records, employee recognition programs, HR projects and annually scheduled efforts such at Open Enrollment, Leave of Absence, HRIS/systems updates and processing, benefits administration, onboarding of new staff, and general administration duties.

This role helps ensure compliance with applicable Federal and State laws and regulatory agency requirements; provides information and assistance to employees regarding human resources activities, processes, policies and procedures; prepares various correspondence and coordinates activities related to the areas of assignment; and delivers a customer-focused and effective HR support service to the department and company.  Responsible for maintaining the privacy and confidentiality of all employee and financial related information and records.

Key Responsibilities

• Supports the HR Business Partner team with HR functional area efforts, projects and initiatives.
• Maintains a high level of confidentiality with sensitive Human Resources matters and materials.
• Coordinates the completion of pre-employment and new hire paperwork e.g., background checks, I-9 forms, and benefit enrollment.
• Coordinates the Exit Interview process and documentation for employees leaving the company.
• Assists with the tracking and reporting of HR related metrics including but not limited to hiring activity, terminations and turnover, employee demographics, training a development efforts for staff, employee service, and other HR related programs and services.
• Assists with the coordination and tracking of staff Leaves of Absences, consistent with FMLA, CFRA, ADA, and all other regulatory laws, rules, and requirements.
• 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.
• Updates employee electronic files and databases to document personnel actions.
• Is accountable for work performed, works to develop, and maintain trusting working relationships with Meritage staff, HR co-workers, leadership, and external business partners.
• 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.
• Performs other than normally assigned duties, as required, within and outside of the HR 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 regular job responsibilities, special projects and other duties as assigned.

• 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.

Job Requirements

Education and Knowledge, Skills and Abilities

Required

• 2-3 years of current and increasingly responsible human resources experience in the areas noted above, with demonstrated understanding of and ability to maintain strict confidentiality of sensitive and private employment related information and material.
• Bachelor’s degree in a related field highly preferred or equivalent combination of formal post high school education and work experience. PHR or PHR certificate in process preferred.
• Proven ability to consistently and positively contribute in a fast-paced, changing work environment with the ability to prioritize multiple functions, tasks, and deadlines.
• Highly organized, detail-oriented, and possess outstanding follow through skills.
• Ability to maintain confidentiality with highly sensitive data.
• Self-starter with a strong sense of urgency and initiative.
• Ability to use computer and learn new software programs; must be proficient in office procedures, methods, and equipment including computers and applicable software applications such as Microsoft Office Suite, including Outlook, Teams, Word, Excel, PowerPoint.
• Excellent data entry and strong documentation skills.
• Must be adaptable and flexible in dealing with a variety of people.
• Possesses ability to communicate effectively, both verbally and in writing.
• Knowledge of HRIS systems and creation of HRIS reports preferred.

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Job Description

Location: Novato , California

Employment Status: Full-Time

Position Summary

Under the direction of the Quality Manager/Supervisor, the Department Coordinator will support the department’s specialty projects and patient outreach programs related to Quality Metrics.

Duties and Responsibilities

• Prepare, disseminate, and follow up on the completion of Quality Metric Open Gap lists to offices.
• Support interdepartmental audits of quality data and the AMP Audit process.
• Represent department as Quality Liaison for practice offices including support of the Cozeva programs.
• Support and implement patient outreach programs (reminder letters, FIT kit mailings, mammogram reminders).
• Outreach to patients to encourage quality gap closure and review quality metrics, Example: encourage medication adherence and identify barriers to compliance and referral to Care Management for additional assistance.
• Ability to navigate multiple EHRs and review medical records, lab results, and progress notes to close quality gaps.
• Proficient in Excel to filter, edit and manipulate data to track quality data closure.
• Other duties as assigned.

Job Requirements

Skills and Requirements

 Highly organized with proven effectiveness at time management and the ability to manage competing priorities.

• Attention to detail and follow-through.
• Skilled in the use of computers and multiple software systems.
• Excellent team communication skills.

 Qualifications

• High level of proficiency in Microsoft Excel required.
• Ability to navigate multiple Electronic Health Records (EHRs) required.
• Bachelor’s degree preferred, or equivalent combination of related work experience and education.
• 2-3 years of work experience in a healthcare-related setting is highly desirable.

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Job Description

Location: Novato , California

Employment Status: Full Time

Position Summary

The Process Improvement Program Administrator supports the organization’s transformation to a continuously improving organization. This position is responsible to lead, facilitate, execute, coach, consult and educate process improvement across Meritage Medical Network. Coaches staff in all aspects of performance improvement methods and tools and has substantial understanding of techniques, processes, procedures to perform the job and seeks to complete tasks in creative and effective ways.  Works on activities of a diverse scope requiring minimal interpretation of policies and guidelines.

Essential Job Functions

• Manages, leads, coaches, and facilitates performance improvement methodologies. Integrates stakeholders into the improvement process utilizing change process
• Translates the theory and science of continuous improvement and innovation into the practical methods that achieve sustainable results
• Integrates process analysis into problem recognition and correction
• Designs experiments and small tests of change to test improvement hypothesis
• Promotes the development of a process improvement competency within the organization
• Supports the development and delivery of process improvement educational materials
• Coaches participants
• Collaborate with and maintain open communication with all departments within Meritage Medical Network to ensure effective and efficient workflow and facilitate completion of tasks/goals
• 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
• 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
• Is accountable for work performed by self, 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 administration and operational areas
• 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 Performance Improvement
• Performs other than normally assigned duties and projects, as directed, and required, within and outside of Performance Improvement to support Meritage’s overall business needs, goals, and objectives

Job Requirements

Education and Experience:

• High School diploma: Associates/Technical Degree or equivalent combination of education/related experience required. Lean Certification preferred.
• A minimum of 3 years’ experience in a healthcare setting, managing multifaceted performance improvement projects
• Must have excellent problem-solving skills
• Excellent interpersonal written and verbal communications skills
• Strong attention to detail
• Enjoys working as part of a team

Required Skills, Knowledge and Abilities:

• Microsoft Office Suite applications: Word, Excel, PowerPoint, etc.
• Knowledge of claim benefit interpretation/benefit adjudication logic
• Must be proficient in problem solving and detecting trends
• Excellent communication skills – meaning you can adapt to new and different situations, read the behavior of others, have difficult conversations with ease and defuse and resolve conflict
• Must be able to read and interpret all types of authorization, medical claim forms and member benefit plans
• Integrity to follow HIPAA guidelines on maintaining patient privacy

Ability to adapt and excel in a fast-paced work environment

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Job Description

Location: Novato California

Employment Status: Full Time

Position Summary:
Is responsible for performing numerous clerical and coordination support functions within the Claims department to ensure efficient departmental workflow and to meet applicable regulatory claims processing requirements.
Essential Job Functions:
• Responsible for all incoming mail.
• Initial triage and redistribute misdirected claims to the Health Plans or other Payors.
• Responsible for daily scanning of incoming claims.
• Reconciliation of qualifying paper claims.
• Identify and route incoming checks to the appropriate department.
• Assist with clerical exception reports.
• Batch, file, and retrieve completed claims forms.
• Assists with the preparation of weekly check runs.
• Assist with claims-related eligibility issues.
• 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.
• 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.
• Is accountable for work performed by self, 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 Claims administration and operational areas.
• 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 the Claims Department.
• Performs other than normally assigned duties and projects, as directed, and required, within
and outside of the Call Center department to support Meritage’s overall business needs, goals,
and objectives.

Job Requirements

Required Skills, Knowledge, and Abilities:
• High School diploma and 1-2 years of related healthcare work experience, or equivalent combination of education, experience, and related skills.
• Experience with office-based computers, keyboards, and related equipment such as printers, fax machines, etc.
• Microsoft Office Suite applications: Word, Excel, PowerPoint, etc.
• Experience working with various electronic medical records systems and databases and confidential handling of patient PHI.
• Strong written, verbal, and listening communication skills.
• Professional demeanor with a positive, approachable, and kind affect.
• Ability to exercise cognitive thinking skills and process new information to incorporate into current workflow and practices.
• Demonstrated ability to work in a fast-paced environment with rapidly changing and competing priorities.
• Proficiency in medical terminology, medical/hospital coding, claims adjudication.

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Job Description

Location: Novato California

Employment Status: Full Time

As a key member of the Network Relations Department, this position serves as a liaison for assigned geographic regions between Meritage and networked physician 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 physician 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.

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.

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 the ability to prepared and present effective individual and group presentation materials.
4. Professional demeanor and work style that projects a confident, open, capable, and trustworthy person that is able to be sustained and maintained in all initial and subsequent interactions with customers and community representatives.
5. 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.
6. Working knowledge and experience 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.
7. 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.
8. Bachelor’s degree in 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.
9. Ability to exercise and be accountable for independent judgment and decision making on organizational and network issues
10. Upon hire, must provide a current Driver’s License and proof of insurance.

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Job Description

Location: Novato, California

Employment Status: Full-time

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.

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 Business Central, 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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