Job Description

Location: Petaluma, CA

Employment Status: Hybrid. Full time

POSITION SUMMARY:

Salary Range: $88,777-104,646 DOE

Hybrid Position

•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.
•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 Compassion.

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Job Requirements

REQUIREMENTS & QUALIFICATIONS:
•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 equivalent combination of education and experience.
•3+ years of data analysis experience.
•High proficiency with data management and analysis tools such as SQL, Power BI, Excel(intermediate).
•Background in at least one of the following areas preferred: Risk Adjustment, HMOs, ACOs, HealthPlans, Utilization Management, Case Management, Pay for Performance, 5-Star, etc.
• Proficiency with or the ability to learn to work in a Microsoft Office environment: Outlook, PowerPoint, Visio, Excel, Word, Teams, Power BI, OneNote, etc.
• Proficiency with or the ability to learn to use project management and collaboration software: Asana, SharePoint.
• Curiosity and willingness to learn.
• 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 group.
• 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.

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Job Description

Location: Petaluma, CA

Employment Status: Hybrid. Full time

Position Summary
The Sr. Claims Examiner is responsible for processing, examining, and adjudicating more complex claims for payment or denial in a manner that maintains compliance within the Medicare and Medi-Cal regulatory requirements while achieving claims service-level objectives. This position will be assigned complex claims as well as provide general support to Claims Examiners and Call Center Representatives.

Salary Range: $24.07/hr. – $28.53/hr. DOE

Essential Job Functions
• Demonstrates in-depth understanding of coverage issues, policies, contracts, and regulatory requirements.
• Proactively and promptly manage claims, considering all aspects with a strategic vision for optimal claim outcome.
• Demonstrate strong technical claims proficiency through consistent execution of best claim practices.
• Review, analyze, and resolve claims through the utilization of available resources for moderately complex claims.
• Present high exposure claims to Claim Leadership and Key Stakeholders.
• Adjudication of claims to achieve quality and production standards applicable to this position.
• Maintain procedural accuracy of 97% and financial accuracy of 99%.
• Look for ways to improve claim efficiencies and outcomes (innovative mindset).
• Ensure legal compliance by following company policies, procedures, guidelines, as well as federal insurance regulations.
• Respond timely to all Customer Service, Provider Relations type questions
• Other duties as assigned by management.
• Collaborate with and maintain open communication with all departments within Meritage Medical Network to ensure effective and efficient workflow and facilitate the completion of tasks/goals.
Updated 3/2023
• 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 Claim’s 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 Claims department to support Meritage’s overall business needs, goals, and objectives.

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Job Requirements

Requirements & Qualifications
• High School diploma.
• A minimum of 5 years experience processing HMO medical claims or billing specialty provider and/or hospital claims.
• Knowledge of DMHC and CMS regulations.
• Comprehensive knowledge of CPT and ICD-10 codes.
• Understanding of technical claims proficiency and execution of best claim practices
• Ability to work independently, multi-task, and remain self-motivated in a fast-paced environment.
• Strong organizational skills and time management of claims desk.
• Must have excellent problem-solving skills.
• Microsoft Office Suite applications: Teams, Word, Excel, PowerPoint, etc.
• Excellent interpersonal written and verbal communications skills.
• Detail-oriented, adaptable, and strategic in decision-making.
• Enjoys working as part of a team.

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Job Description

Location: Petaluma, CA

Employment Status: Full time

Position Summary
The Senior Human Resources Business Partner (Sr. HRBP) performs and leads a variety of complex Human Resources functions which include, but are not limited to, all aspects of Health & Welfare Benefits, Retirement Plan administration, Leaves of Absence administration, onboarding or offboarding of staff, and HRIS maintenance. The Sr. HRBP researches, analyzes and advises management on best practices relating to employee relations and strategies. The Sr. HRBP works as part of a cohesive HR team and cross-functionally with leadership and the Accounting/Payroll department; and serves as a trusted partner to all staff, external partners, and vendors.

Salary Range: $78,811.20- $93,392 DOE

Essential Job Duties
• Develops and administers employee health, welfare and retirement program.
• Assists with the planning, development and drafting of materials and processes associated with annual Benefits Open Enrollment. Assists with annual benefit fairs by working closely with HR team members, health plan brokers and benefit carriers.
• Presents benefits program to new employees and to all employees during annual Open Enrollment.
• Assists in the implementation, administration, and communication of employee benefit plans. Makes presentations on benefit programs.
• Responsible for oversight of benefit invoice reconciliation.
• Responsible for benefits administration including directing and planning the day-to-day operations of the group benefit plans. Presents, advises, and informs employees of the details of the company’s benefits program. Liaises with third-party benefit and retirement plan vendors.
• Administers all Leaves of Absence (LOA), including record keeping, follow-up, and providing written notifications to employees according to established procedures and leave/employment laws.
• Onboards new employees, and conducts Exit Interviews with terminating employees.
• Responds to and follows up on EDD requests following terminations of employment or applications for State Disability Insurance.
• 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 and to provide information for payroll and other uses.
• Works closely with and acts as primary back-up for the HR Manager and assumes assigned duties in their absence.
• 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 a variety of HR-related employee recognition, employee relations, staff development and internal communications assignments and projects.
• 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.

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Job Requirements

Minimum Qualifications & Requirements
• Bachelor’s Degree in Human Resources or related field.
• Minimum of 5 years of current, related HR experience, preferably in the healthcare industry; or equivalent combination of education, work experience, and skills.
• HR Certification preferred.
• Proficient in MS Office Suite (Word, Excel, PowerPoint, Publisher, Outlook, and Teams) and a strong working knowledge using Excel (e.g. V-Lookup and formulas).
• Maintains a prominent level of confidentiality and has a working knowledge of applicable federal, state, and municipal regulations as they relate to human resources.
• 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.
• Excellent written and verbal communication skills including effective listening and in-person or virtual presentations.
• 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.
• Ability to work in a fast-paced environment with rapidly changing and competing priorities.
• Takes initiative and determines best course of action for a vast array of HR issues by accessing all available resources.

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Job Description

Location: California Remote

Employment Status: Full-Time

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

Salary Range: $29.19/hr. – $34.60/hr.

Primary Responsibilities:
• Complete pre-reviews to inform physicians of any outstanding HCC.
• Complete post-review to ensure all codes on the claim are documented in the chart note.
• Provide feedback to physicians and remove codes when documentation does not support coding via charge entry or delete file process.
• Add additional HCC codes when substantiated in the chart note and not on claim via charge entry or supplemental data process.
• Maintain Continued Education Units (CEU) for credentials in addition to any new coding guidelines as it pertains to HCC/Risk Adjustment.
• Assist in educating physicians and staff regarding coding procedures and policies to ensure compliance.
• Maintain HIPAA compliance at all times.
• Adhere to CMS coding guidelines and OIG regulations at all times.
• Monthly updates and reporting to provider network regarding AWV completeness and recapture rates.
• Maintain excellent customer relationships with physicians, medical office staff, health plan partners and internal departments.
• Complete scheduled and ad-hoc chart reviews for provider network and health plans.
• Track coding trends when completing chart reviews and report back to leadership, provider network and/or health plans.
• Contributes to the team’s effort and success by accomplishing delegated tasks on time and meeting daily and weekly job goals.
• Promotes a team approach by encouraging communication among all members of the Risk Adjustment team.
• 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 Compassion.
• Performs other duties and projects as assigned that support the Care Management Team and other areas, departments and programs within the Meritage organization.

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Job Requirements

Minimum Qualifications & Requirements:
• High School diploma or equivalent (e.g. General Education Diploma “GED”).
• CPC or CCS certification required. CRC certification preferred.
• Minimum of 1 year of risk adjustment coding; current medical background with chart review experience; 2 years of customer service experience in a healthcare related setting.
• Expertise in RAF/HCC, ICD-10-CM and CPT.
• Working knowledge in HCC coding.
• 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.
• 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.
• Flexible and adaptable to change.
• Experience with Accountable Care Organization (ACO) or Direct Contracting Entity (DCE), preferred.

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Job Description

Location: Petaluma, 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.

Salary Range: $88,777 – $104,646 per year

DUTIES & RESPONSIBILITIES:
• Develop and maintain analytical models for revenue analysis, membership, claims triangles and Power BI reports.
• Lead activities related to the production of financial reports and results of operations.
• Provide insights for evaluating, recommending, maintaining and monitoring appropriate internal controls and related documentation.
• Perform ad hoc reporting and analysis and investigating issues, providing explanations and interpretation.
• 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.
• Ensure data from support services departments promote reliability and accuracy of information.

ADDITIONAL DUTIES & QUALITIES:
• 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

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Job Requirements

MINIMUM REQUIREMENTS & QUALIFICATIONS:
• Bachelor’s degree in Accounting, Business, Finance or related field of study; or equivalent combination of education and experience; MBA preferred.
• Minimum of 4+ years of experience in a Finance or Accounting related role with extensive knowledge of analyzing, interpreting, and reporting financial data.
• Minimum 3 years current healthcare related financial planning and analysis work experience preferred.
• Strong knowledge of and experience with Microsoft Office (Advanced Excel); Advanced skills in the creation of pivot tables, charts and formulas such as VLOOKUP and IF statements.
• 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.
• Advanced proficiency with Power BI or similar advanced reporting tools.
• Demonstrated advanced knowledge of and direct application of US Generally Accepted Accounting Principles (GAAP).
• Proven success collaborating with internal and external stakeholders.

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Job Description

Location: Petaluma, CA

Employment Status: Full time

 Position Summary

As a key member of the Business Services Department, serves as a primary point of contact for all aspects of credentialing and re-credentialing for physicians, advanced practice providers and organizational providers. The Coordinator works to develop and maintain a streamlined, efficient, and automated process for credentialing and re-credentialing in compliance with contracted health plans and National Committee for Quality Assurance (NCQA) requirements and per organization’s policies and procedures. This position works closely with other Meritage staff (e.g., Contracting, Network Relations, Claims and Utilization Management Department) to ensure providers are added to the network in a timely manner.

Salary Range: $24.07- $28.53 DOE

Essential Job Functions

• Maintains up-to-date data for each provider in computer database by ensuring timely review of licenses and certifications renewals.
• Reviews and screens initial and recredentialing applications for completeness, accuracy, and compliance with federal, state, and local guidelines, policies, and industry standards.
• Identifies and resolves discrepancies, time gaps and other issues that could delay completion of the credentialing process.
• Query monthly reports for expirable information (e.g., licenses, DEA, & malpractice insurance) and update database with new information.
• Communicates clearly with providers or their staff as needed to provide timely responses to requests for additional credentialing information or issues as they arise.
• Prepares credentialing files for presentation at the Membership Committee; responsible for confirming the completeness of information and all documentation prior to presentation.
• Prepares custom reports from the department database for uploads to CVO and VerifyComply.
• Maintains all the credentialing documentation are up to health plan audit standards and coordinates with Director and/or manager health plans for annual credentialing audits.
• Maintains confidentiality of provider
• 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.
• Responsible for all aspects of credentialing/re-credentialing providers, to include but not limited to verification of application/documents, mailing of requests for consideration, initial applications, approval, denial, termination letters, tracking license and certification expiration for providers, and accurately loading/maintaining provider information into the Credentialing database.
• 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.
• 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
• Performs other duties as assigned related to supporting the Credentialing Department and the overall Meritage organization.

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Job Requirements

Qualifications & Requirements

• Bachelor’s degree in a healthcare, business, or related field of study; or equivalent combination of education and experience.
• Minimum 2 years’ related work experience, with 1 year of current credentialing work experience, preferably in a managed care setting.
• National Association Medical Staff Services (NAMSS), Certified Provider Credentialing Specialist (CPCS) preferred.
• Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation.
• Knowledge of Internet resources and regulatory agencies such as Medical Board of California, Drug Enforcement Administration (DEA), National Practitioner Data Bank (NPDB), and Office of Inspector General (OIG), etc.
• Working knowledge and experience with office-based computer equipment, systems and applications (e.g. MS Office Suite: Word, Excel, PowerPoint, Outlook, Teams, Adobe and Publisher).
• Able to use independent judgment and to maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications.

• Strong written and verbal communications skills.

• Excellent customer services skills with a demonstrated genuine and friendly demeanor.
• Detail orientation with the ability to organize and prioritize work and manage multiple priorities with mature judgement.
• Demonstrated ability to work and communicate efficiently and effectively with physicians and their staff on credentialing matters.
• Ability to multi-task and meet deadlines and agreed upon deliverables.
• Ability to problem solve and research and analyze data, discrepancies, and variances.
• Ability to work independently with minimal

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