Job Description

Location: Novato

Employment Status: Full Time

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

Core Requirements

• Proficiency with data management and analysis tools such as: Microsoft Access, Power BI, and Excel
• Ability to quickly learn and master new software systems
• Experience working with relational databases with complex architecture and table structure
• Ability to develop and support in-depth reports that show nuanced and complicated clinical data, including the ability to teach end users how to interpret content
• Excellent written and verbal communication skills, including designing and presenting reports to internal and external groups
• An understanding of basic corporate finance principles
• Critical thinking and independent problem resolution skills
• Ability to prioritize workload to meet deadlines for short and long-term goals with competing timeliness.

Software and Tools

• High proficiency with Microsoft Excel
• Proficiency with or the ability to learn to work in a Microsoft Office environment: Outlook, PowerPoint, Visio, Excel, Word, Power BI, OneNote, etc.
• Proficiency with or the ability to learn to use project management and collaboration software: Asana, SharePoint

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Job Requirements

Education and Experience

• Ideally, 2+ years of data analysis experience
• Ideally, a background in at least one of the following areas: Risk Adjustment, HMOs, ACOs, Health Plans, Utilization Management, Case Management, Pay for Performance, 5 Star, etc.
• Bachelor’s degree or related study in one of the following areas: Statistics, Computer Science, Data Science, Informatics, Population Health, Healthcare Administration, Finance, Economics, etc., or a combination of education and experience.
• Curiosity and willingness to learn

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Job Description

Location: Novato

Employment Status: Full-Time

The Utilization Management Coordinator serves as a liaison between Meritage Medical Network, our contracted health plans, Network physicians and Members. The incumbent is responsible for intake of all requests for medical services. Must have the ability to understand and use set criteria and approve specific services within the related UM system.

Principle Duties and Responsibilities:
• Ensure prompt, accurate data entry of Authorization requests into the MedVision system
• Utilize knowledge and experience to analyze contractual or administrative issues related to the requests.
• Identify additional information needed and ability to research and understand Policy benefits and criteria
• Accurately identify when and how to refer cases to appropriate clinical personnel or take other actions.
• Follow strict guidelines to ensure all work meets ICE standards for accuracy, timeliness, quality and compliance with federal, state and accreditation regulations.
• Coordinate with other insurance coordinators and the medical review staff.
• Consistently meet department productivity and performance metrics.
• Contribute to the efficiency of the department by being flexible and cross-trained on other functions.

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Job Requirements

Qualifications:
• 1 – 2 years of related experience.
• Familiarity with Medical terminology required
• Familiarity with insurance billing and terminology preferred
• Managed Care experience, preferred.
• Knowledge of CPT and ICD codes.
• Strong data entry skills.
• Excellent interpersonal skills, including phone, verbal, and written communication.
• Ability to cope in a fast-paced production environment
• Demonstrated knowledge of customer service skills when responding to questions and other inquiries from internal and external customers.
• Strong computer skills with demonstrated proficiency in Excel, Outlook and other Microsoft Office applications.
• Must be organized and detail oriented.

Education:
• High School Diploma required.
• Coding certificate or Medical Assistant graduate desirable

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