Job Description

Location: Novato , California

Employment Status: Full Time

Position Summary

The Performance Improvement Project Manager 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: On-Site Novato, CA

Employment Status: Full Time

Position Summary

Under the direction of the Clinical Coding Supervisor will support the department’s efforts in managing patient care and patient outreach programs. The CM Coordinator will assist the CM Staff, RN, and/or SW, in administrative tasks to manage the patients’ clinical needs.

CM coordinators must be able to problem-solve, work well with patients and vendors, and have a basic understanding of health systems. CM department has several programs to manage the MMN population including Care Transitions, Complex Care Management, disease-specific programs, ED program, Behavioral Health Liaison, and basic Care Coordination. The CM Coordinator must be familiar with all the programs and provide support as tasked by the CM team. The CM Coordinator should be resourceful and work well in a team.

Examples include, but are not limited to: Helping patients order durable medical equipment (DME), obtaining notes from provider offices, assisting patients in the schedule to follow up appointments and ordering medications, faxing providers, mailing clinical resources to patients, and maintaining a list of active community resources and procedures for a referral.

Department administrative duties:

• Assist any member of the Care Management department staff as needed
• Call patients, offices, vendors in support of patient care activities
• Maintain meeting minutes and records
• Mailings and data entry for special projects
• Able to navigate the network and provide guidance to patients
• Navigate several electronic health records (EHR) systems

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
• 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.

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 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, CA

Employment Status: Full Time

The Claims Manager oversees the day to day operations of the Claims Department to ensure the accurate and timely processing of members’ medical claims. Responsible for administering claims payments and providing counsel to staff and claimants regarding coverage amounts and benefit interpretation.  Monitors and controls backlog and workflow of claims.  Ensures that claims are settled in a timely fashion and in accordance with cost and quality control standards. Regularly demonstrates an open, flexible and inclusive work style with staff, colleagues and external business partners, vendors and related parties.  Emanates an approachable, confident, competent and professional demeanor.

Essential functions:

• Manages and develops a team focused on meeting or exceeding established performance targets and quality goals. Targets may be based upon health plans, federal or state requirements as dictated.
• Proactively plans for daily priorities as well as responds to new priorities within the organization and opportunities assigned from upper management.
• Responsible for compiling, analyzing, and submitting daily, weekly, and monthly departmental reports and metrics to management and health plan partners.
• Acts as a technical expert in handling and resolving as appropriate, complaints and other escalated issues from internal and external customers.
• Supports claims performance improvement via participation in special claims initiatives.
• 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 claims 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 claims 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 Claims 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. Provides required training and education regarding policies and procedures to internal and external Claims staff, vendors and other business partners.
• Conducts other claims department financial, workflow and volume related analysis to support company and management objectives and decision-making.
• Ensures departmental efforts and activities adheres to all Claims related professional and regulatory standards and applicable industry benchmarks.
• 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 Claims administration and operational areas.
• 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.
• Adopts, incorporates, is mindful of, and otherwise supports Meritage’s overarching annual and longer-term strategic business goals and objectives while performing work duties, special projects and other duties as assigned within or outside of Accounting. 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

Required Education:  Bachelor’s Degree or equivalent combination of education and experience.

Required Experience:

• Extensive knowledge of Commercial and Medicare Advantage health insurance claims payment methodologies
• Medical terminology, ICD-10, CPT, HCPCS, and Institutional coding experience
• Microsoft Office Suite applications: Word, Excel, PowerPoint, etc.
• 7 – 9 years of medical claims operations experience, preferably in a managed care environment
• 5 – 7 years of healthcare supervisory experience

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Job Description

Location: Novato, CA

Employment Status: Full Time

The Accountable Care Programs Project Manager (ACPM) is responsible for overseeing the successful development, coordination, and implementation of a wide variety of innovative projects and programs that support the delivery of coordinated high-quality value-based patient care and incentives among network providers.  Assigned projects will focus on provider education and engagement across the healthcare continuum to align with best practice guidelines, quality metrics, and related efforts to ensure patients receive the right care at the right time, while avoiding unnecessary and duplicative services.  Must be or become a subject matter expert on Direct Contracting Entity (DCE) and Accountable Care Organization (ACO) programs and initiatives; and, well versed with CMS guidelines on these and related programs, practices and opportunities.

Duties and Responsibilities:

1. Establishes and develops working project teams with leadership and staff representation from identified Meritage departments, the provider network(s), and other internal and external groups and business partners.
2. Establishes project plans with timelines, with key measurable deliverables for each phase of the project through completion.
3. Works to identify and define key metrics to measure, report and communicate success in relation to established benchmarks, best practices and performance targets.
4. Develops and works to maintain a culture of engagement, cooperation, collegiality, harmony and accountability for each project team in order to maximize excellence of outcomes.
5. Facilitates, and takes an active part, in the individual and collective efforts and output of contributing project team members, and other internal and third-party project stakeholders.
6. Ensure all aspects of assigned projects are completed within established timeframes and meet quality, efficiency and financial targets.
7. Schedules, organizes, maintains and leads project team meetings, materials, agenda’s, meeting minutes, plans, records, and metrics for assigned projects and project teams.
8. Demonstrates ownership and accountability for the success of assigned projects and work teams, adjusting, streamlining and enhancing efforts, activities and communications as appropriate and necessary to achieve established outcomes.
9. Serves as primary accountable contact for assigned projects, manages expectations, escalates issues as appropriate, and handles and resolves obstacles and challenges impacting progress in a timely manner.
10. Reports and presents progress, recommendations and outcomes of assigned initiatives to senior management and other stakeholders for executive decision making.
11. Oversees all aspects of execution and implementation of project deliverables, including identifying and solving problems that would otherwise delay the implementation of assigned project work.
12. Is responsible for working within an established budget and raising any unanticipated variances, costs and financial considerations that may occur over the course of each project assignment.
13. Models professional work standards and behaviors to support a professional working atmosphere and maintains strict confidentiality of patient and practice data with other Meritage staff, internal and external customers and work partners
14. Is accountable for work assigned and performed, works to develop and maintain trusting working relationships with others, and seeks to continuously improve and learn from errors and experiences.
15. Actively stays abreast of current and new standards, practices, technology, resources, and general developments in Healthcare and job specific areas.
16. Performs other than normally assigned duties and projects, as directed and required, to support Meritage’s business needs and objectives.
17. Adopts, incorporates, is mindful of, and otherwise supports Meritage’s overarching annual and longer-term strategic business goals while performing work duties, special projects and other duties as assigned.
18. 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
19. Continuously endeavors to “raise the bar” of performance and teamwork through a focus on Innovation, Collaboration, Equality and

Job Requirements

Qualifications and Requirements:

• Bachelor’s degree from an accredited college or university in business or public administration, economics, heath care or related field, and 3-5 years of current and progressively responsible project management experience in the healthcare industry; or equivalent combination of education and work experience.
• Project Management certification from an accredited college or university highly preferred.
• Must have experience working effectively and collaboratively with healthcare leadership, staff and physicians.
• Strong interpersonal skills, as well as strong verbal, written and listening communication and presentation skills.
• Professional, credible, confident and approachable demeanor.
• Demonstrated experience in managing multiple projects effectively while facilitating group success will be critical to the project manager role.
• Computer proficiency and knowledge will be essential to accomplishing day-to-day tasks successfully.

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Job Description

Location: Novato California

Employment Status: Full Time

Job 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.  Works as part of a Claims team to ensure the even distribution of work, support coworkers with routine work and special projects, to accomplish departmental goals and objectives.  Duties include but are not limited to:

• Open, date, sort, scan, and distribute departmental mail and supplies.
• Identify and direct specific claims and correspondence to the appropriate Claims Examiner or other Claims staff.
• Completes clerical exception reports.
• Enters routine claims information into assigned systems, spreadsheets, and databases.
• Batch, file, and retrieve completed claims forms.
• Supports clerical needs for routine and focused claims audits, including but not limited to gathering required supporting policies, procedures, and records and plans, preparing and generating necessary reports.
• Assists with the preparation of weekly check runs.
• Distribute assigned reports, including daily edit and errors reports.
• Maintain claims department inventory tracking system.
• Assist with claims-related eligibility issues.
• 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.

Job Requirements

Requirements

• 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.
• Working knowledge and experience with Outlook, video conferencing applications (e.g. Teams/Zoom), Excel, and Word.
• 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.

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Job Description

Location: Novato , remote California

Employment Status: Full-Time

The Network Contracting Coordinator is responsible for performing numerous clerical and coordination support functions within the Contract Department in support of daily operational activities, assigned projects and other clerical support duties deemed necessary for the department to complete assignments, meet deadlines and overall department success.  A strong focus will be on maintaining electronic contract files, including tracking of contracts in negotiations, completing contract cover sheets, and ensuring all supporting documents are complete and accurate to include regular auditing of information maintained in multiple systems.  Will assist in general outreach calls to providers and Health Plans, respond to general department inquiries via telephone and email, and serve as the point of contact for assigned projects.

PRIMARY DUTIES AND RESPONSIBILITIES

• Completes provider contract updates, to include demographic and contract changes, for submission to the Network Relations team.
• Completes Contract Cover Sheet ensuring all data inputted is complete, timely and accurate to include any required supporting documents as well as obtaining various department approvals.
• Assist in researching, in collaboration with the Network Contracting Specialist, issues regarding provider data, fee schedules, configuration, originating from various departments as assigned.
• Provides on-going auditing of the contract database through various reports, research and outreach via email and phone calls.
• Maintains organization of files on departmental shared drives, assigned systems and databases to ensure such information is up-to-date and easily accessible.
• Recommends process, practice and procedural changes and improvement to streamline, simplify and strengthen department efficiencies in assigned areas.
• Assists in the gathering, coordinating, and reporting of various contract department data grids for use by other departments as required.
• Handles all aspects of department mailings, including securing needed supplies, organizes, compiles, and prepares materials for mailings. If non-electronic outgoing mail is needed, will operate equipment used to stuff, fold, and seal envelops before running envelops through the postage machine.
• Accountable for work performed, works to develop, and maintain trusting working relationships with staff, co-workers, leadership, and external business partners, e.g. Health Plan and provider representatives.
• Provides excellent internal/external customer service, maintains a professional work attitude and approach, works well and in a positive manner with all other Meritage staff, and maintains strict confidentiality
• Performs related work as required, special projects and other duties as assigned, within or outside of the Contracting department.
• 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

Job Requirements

MINIMUM REQUIREMENTS AND COMPETENCIES:

• Associate degree with two (2) years related experience, or equivalent combination of education and experience.  Managed Care experience preferred.
• Strong attention to detail and organizational skills a must.
• Effective written, verbal and listening communication skills.
• Ability to learn and utilize company database systems, i.e., QuickCap.
• Proficient with MS Office (Word, Excel and Access), Outlook and Internet.

• Demonstrates a strong customer service orientation, including a professional and respectful demeanor with customers, co-workers, and other business partners.
• Strong sense of accountability for work conducted and expected deliverables.

• Processes contract related forms efficiently and accurately.
• Knowledge of provider data elements, provider contracts, claims a plus.

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Job Description

Location: Novato California

Employment Status: Full Time

Position Summary:  The Meritage Broker Liaison is responsible for establishing, developing, maintaining, and managing all new and existing health insurance broker relationships and ensuring brokers are equipped to speak to Meritage Medical Network and its MA plans to their clients.  The Liaison is responsible for helping to grow the number of lives within Meritage Medical Network(s).  The Liaison will regularly demonstrate an open, flexible, and inclusive work style with internal Meritage staff and leadership, and external business partners, vendors, and related parties.  Emanates an approachable, confident, competent, and professional demeanor.

Primary Duties

• Maintains continual active outreach (initiating outbound calling, lunches, coffee meetings, etc.) to new and existing broker partners to ensure they are truly engaged with the Meritage business.
• Serves as the primary interface for brokers and broker staff providing education on features, advantages, and limitations of products, eligibility, and Health Alliance policies and procedures in order to promote sales.
• Assists in building and developing effective marketing and promotion plans for all Medicare Advantage enrollment periods (AEP, OEP, Age Ins).
• Makes oneself available to brokers and health plans for enrollment events to represent the Meritage organization and Network(s).
• Establishes strong and effective working relationships with community, private and public organizations with a high focus on serving the Medicare population.
• Promotes Meritage health plan partner products in compliance with Centers for Medicare & Medicaid Services marketing guidelines.
• Evaluates and recommends sponsorship opportunities and represents in person at community events, presentations, expos, and health fairs.
• Participates in the identification of promotional materials and specialty items for distribution.
• Coordinates, hosts, and/or speaks at community events sponsored by Meritage Medical Network and affiliated health plans.
• Performs administrative tasks such as maintaining records and preparing monthly reports on key metrics and measures for demonstrating the effectiveness of broker outreach relationships and activities to the Meritage Networks and revenue streams.
• Performs Compliance monitoring and oversight to ensure contracted brokers and broker staff are adhering to marketing regulations established by the Centers for Medicare & Medicaid Services and policies established by Health Alliance.
• Models professional standards to others, ensuring strict confidentiality of all business and Network-related data, files, records, and information and are protected by regulation and/or proprietary requirements.
• Works with supervisor and co-workers to establish department-specific annual goals and objectives, and tracks and reports on progress towards meeting identified department goals and efforts that are specific to the effectiveness of broker relationships.
• As appropriate and required, actively partners with internal Meritage co-workers, staff, and leadership to work on cross-functional work efforts and projects and for strengthening internal lines of communication with other departments.
• Assists with assessing, developing, drafting, disseminating, and implementing policies, procedures, and work processes to maintain and strengthen department efficiencies, accuracy, compliance, and internal controls.
• Models excellent customer services standards and behaviors to maintain and strengthen a professional and positive work atmosphere within the department, with other Meritage staff, and with all external customers and partners.
• Is accountable for own work performed, 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 areas.
• Performs other than normally assigned duties and projects as assigned, within and outside of the home department to support Meritage’s overall business needs.
• 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 home 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

Job Requirements

Required Education:  Bachelor’s Degree in applicable area of study or equivalent combination of education and experience.

Required Experience, Knowledge, and Skills:

 Excellent presentation, communication, and relationship-building skills.

• Professional, confident, polished, and approachable demeanor.
• Minimum 3 years’ current experience in a broker relations position; experience on the physician practice side of healthcare and knowledge of IPA’s preferred.
• Strong understanding of Medicare Advantage plans, benefits and programs, and CMS compliance
• Microsoft Office Suite applications: Word, Excel, PowerPoint, etc.

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Job Description

Location: Novato California

Employment Status: Full Time

Summary

As a key member of the Network Relations Department, this position serves as a liaison for assigned geographic regions and Ancillary Service Providers. The Ancillary Services Provider Liaison will travel to and handle matter 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 3 days per week working in the field with network provider offices and 2 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.

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 the 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. 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.
8. 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.
9. 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.
10. 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 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, CA

Employment Status: Full Time

Position Summary

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

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

Additional Duties and Qualities

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

Job Requirements

Requirements:

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

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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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Job Description

Location: Novato, California

Employment Status: Full Time

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

Key Responsibilities

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

Job Requirements

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

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Job Description

Location: Novato, CA

Employment Status: Full Time

Position Summary:

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

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

Job Requirements

Required Qualifications:

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

Minimum Experience

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

Education/Licensure:

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

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