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View BenefitsLiaison for Medical Network Members
Location: Novato
Liaison for Medical Network Members
Job Description
Location: Novato
Employment Status: Full Time
As a key member of the Network Relations Department, serves as a liaison for assigned geographic regions between Meritage and networked 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.
Go to applicationJob Requirements
- Strong demonstrated customer services skills and commitment.
- Strong organizational skills with an attention to detail and the ability to multitask and juggle multiple priorities effectively.
- Demonstrated excellent written and verbal communications skills, with ability to prepare and present effective individual and group presentation materials.
- 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.
- Ability to confidently and clearly present information in a large group setting.
- 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.
- 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.
- 3-5 years’ experience working with physician and physician practices, their staff and affiliated businesses, e.g., 3rd party suppliers and vendors, insurance companies, etc.
- 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.
- Ability to exercise and be accountable for independent judgement and decision making on organizational and network issues
- Upon hire, must provide a current Driver License and proof of insurance.
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Cloud Systems Developer
Location: Novato, CA
Cloud Systems Developer
Job Description
Location: Novato, CA
Employment Status: Full Time
Meritage Medical Network has an immediate opportunity for a full-time System Developer to assist in implementing advanced software cloud systems.
At Meritage, we are committed to Excellence. We consistently demonstrate behaviors, conduct and communications that support Meritage’s Practices and Values of Accountability, Diversity, Integrity and Respect for others. Meritage is a leader in Healthcare and we continuously seek to raise the bar through Innovations, Collaboration, Equality and Compassion. There’s a reason Meritage just won The North Bay Business Journal’s Best Places to Work Award for a fourth consecutive year.
The System Developer’s work includes:
- Software prototyping and construction – Design, Build, and Modify existing business-tier components, Web applications, and database objects using Microsoft platform technologies (ASP.NET Web API) and Azure.
- Creating prototypes, as required, to validate proposed solutions and seek feedback from stakeholders.
- Following test-driven development and continuous integration practices.
- Working with interdisciplinary Team Leads to properly define/clarify business requirements, development estimation, and work plan finalization.
- Performing unit and integration testing on all developed code – create and execute unit and integration tests within development lifecycle.
- Proactively benchmarking application code to mitigate performance and scalability issues.
- Working with our Quality Assurance Team on issue reporting, resolution, and change control.
- Supporting and troubleshooting with the Operations Team on any environment issues during application deployment across Development, QA, Staging, and Production environments.
- Assisting other teams with troubleshooting problems that may arise from applications or integration of various components
Job Requirements
Minimum Job Requirements:
A Bachelor’s Degree in Computer Science or related field; a minimum of 1-year experience working with “GIT” as source control and understand the concepts around pull requests, branches, and repositories; or, an equivalent combination of education and related work experience.
Must have experience with:
- REST API/ Web API creation, consumption, integration using Service Oriented Architecture.
- Microsoft Azure (Azure SQL, Storage, Web apps, web roles, worker roles, Service Fabric, IoT Hub).
- Working with global enterprise applications.
- Unit test frameworks (Microsoft Unit Test Framework, MOQ)
- Agile Software Development.
- The .NET framework and other technologies: C#, Web API, and Microsoft Azure.
- Advanced Object oriented programming, data structures, dependency injection and multi-threading,
- Angular JS 1.7 or another Java Script Frontend Framework.
- Creating high-level, low-level design documentation using UML.
If this sounds like the job and work environment for you and you meet our job requirements, please send us your resume and a cover letter, explaining your strengths for this position and why you would be a good fit at Meritage to…..(insert how we are having applicants apply for our jobs).
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Contracting Specialist
Location: Novato, CA
Contracting Specialist
Job Description
Location: Novato, CA
Employment Status: Full Time Non-Exempt
SUMMARY:
Under the general supervision of the Director of Contracting, this position will primarily focus on ensuring the acquisition, servicing and performance of Ancillary and Specialty Network Provider contractual agreements in the Meritage network, including proper and comprehensive record keeping and tracking of those agreements and other contractual agreements maintained in the department. Creates, develops and maintains various tools, resources and reference matrixes in support of Network Relations, Utilization Management and other departments as needed. Performs other contracting and affiliated duties that support the success of Meritage’s business goals and operations as assigned.
You will be committed to Excellence in supporting our physicians, our communities and our colleagues as we care for our patients. You consistently demonstrate behaviors, conduct and communications that support Meritage’s Practices and Values of Accountability, Diversity, Integrity and Respect for others, and seek to influence these behaviors in others. Meritage is a leader in Healthcare and our employees continuously seek to raise the bar through Innovations, Collaboration, Equality and Compassion.
DUTIES AND RESPONSIBILITIES:
- Negotiate and finalize ancillary and specialty network contracts based upon network analysis and established parameters.
- Work to ensure that contracting efforts are strategic in nature, align with company goals and objectives, and results in an effective and high-quality network.
- Ensure contracts are administered and implemented accurately to include verifying system set-up within QuickCap (claims data system) and other business systems and databases as assigned and required.
- Manage and maintain electronic contract files to ensure the most current and complete contract files are easily available on- line and systems as established to track renewal and expiration dates of agreements in advance, as applicable. As well as applicable BAA’s and NDA’s are current and on file.
- Work with internal departments to negotiate Letter of Agreements with non-contracted physicians and ancillary providers.
- Works independently on minimum to moderately complex projects/assignments.
- Prepare network analysis quarterly reports and dashboards in order to identify gaps in the network as well as provide accurate network availability for both internal and external customers.
- Track and trend data and identify potential contracting or service-improvement opportunities.
- Develops, maintains and provides reports from the Power BI database and prepares custom reports, data searches and/or data analysis in response to specific requests by internal customers.
- Coordinate with the Claims department to find resolution of ancillary and LOA provider claim disputes.
- Responsible for evaluating and recommending enhancements in current processes or developing new processes/procedures to improve overall efficiency and effectiveness of the contracting department.
Job Requirements
MINIMUM REQUIREMENTS AND COMPETENCIES
- Bachelor’s Degree in healthcare or business administration and a minimum of two years’ experience in negotiating professional and/or ancillary provider contracts or equivalent experience to support negotiations; or, an equivalent combination of education and directly related work experience.
- Considerable knowledge of Managed Care, HMO and Medicare Advantage lines of business.
- Working knowledge of claims payments and processes required.
- Working knowledge and understanding of provider contracting models to include capitation, fee for service and flat rate fee schedule.
- Demonstrated ability to consistently model and maintain professional behaviors, communications and conduct that are aligned with and support Meritage’s company values and practices of work Excellence, Accountability, Integrity, and Respect for others; and, can influences these behaviors in others.
- Detail oriented with the ability to organize and prioritize work and manage multiple priorities with mature judgement.
- Ability to set objectives and prioritize workload to meet the objectives and deadlines of projects/assignments.
- General financial and analytical skills
- Ability to work with and maintain confidential information and comply with HIPAA requirements related to PHI.
- Experience in provider relations and client services preferred.
- Strong ability to express ideas clearly in both written and oral communications.
- Ability to develop, organize, analyze and implement processes and procedures.
- Proficiency with Microsoft applications Word and Excel required to include video conferencing platforms such as Teams, Zoom and/or WebEx.
- Effective interpersonal skills.
- Problems and issues faced are general and may require understanding of broader set of issues, but typically are not complex. Problems may require understanding of other job areas. Problems are typically solved through drawing from prior experiences, with analysis of the issue. May make significant departures from traditional approaches to develop solutions.
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Clinical Coding Specialist-Certifie...
Location: Novato
Clinical Coding Specialist-Certifie...
Job Description
Location: Novato
Employment Status: Full Time
Position Summary
Clinical Coding Specialists are responsible for reviewing patient medical records for Medicare Advantage enrollees, and other groups/populations as assigned, to identify chronic conditions to be prioritized and addressed by healthcare providers. The review process includes working with multiple electronic health records, completing of pre-appointment reviews, completing post appointment reviews and reviewing capture of chronic conditions for physician incentives. They must maintain best practices for accurate data collection and adhere to Meritage policies and procedures.
Primary Responsibilities
- Evaluate the patient’s medical record and reports from the health plan to identify and document potential chronic conditions to be addressed by healthcare providers.
- Complete post-appointment review to assess HCC capture by providers and document findings.
- Work with team to ensure ICD10 codes submitted by physicians are supported by documentation and provide feedback to inform physician education.
- Review, assess and provide feedback to mid-level providers conducting home visits.
- Document any additional HCC codes, when clinically indicated, on the ICE file.
- Report any findings of noncompliance for issues not related to HCC in the Secondary Pursuit file.
- Collaborate with team members to research or answer any coding questions that may arise.
- Assist in education of providers and staff regarding coding procedures and policies to ensure compliance.
- Respects patients by recognizing their rights and maintaining confidentiality.
- Promotes a team approach by encouraging communication among all members of the care team.
- Contributes to the team’s effort and success by accomplishing delegated tasks on time and meeting his/her daily and weekly job goals.
- Communicate with providers regarding HCC capture via the EHR tasking system.
- Maintain excellent customer relationships with providers, medical office staff, other department staff and health plan representatives.
- Complete assigned tasks daily and in a timely manner.
- Maintain current coding credential (if applicable).
- Assist in the training and orientation of new staff as directed.
- Performs other duties and projects as assigned that support the Care Management Team and other areas, departments and programs within the Meritage organization.
Job Requirements
Qualifications
- Minimum of 1-2 years current medical background with chart review experience.
- Working knowledge of medical terminology, anatomy and physiology, disease processes and pharmacology.
- Able to work effectively on an independent basis or as part of a larger work team.
- Demonstrates critical thinking skills, sound judgement and a solid sense of accountability.
- Able to concurrently use different electronic health record systems as needed.
- Detail oriented and able to work as a collaborative and positive team member.
- Strong written, verbal and listening communication skills.
- Expertise in ICD-10-CM and CPT and RAF.
- Demonstrates a professional demeanor and excellent customer services skills
- Treats others in a respectful, kind and patient manner
- Self-motivated and able to ask for assistance when needed.
- Unrestricted driver’s license and automobile insurance.
- Flexible and adaptable to change.
Education and Experience Requirements:
- Graduate of an accredited coding program with coding certification is strongly preferred, CMA program, or current applicable medical office/chart review experience.
- One year of previous recent procedural/diagnosis coding, or equivalent work experience.
- Two years of customer service experience in a healthcare related setting.