Job Description

Location: Novato, CA

Employment Status: Full-time

Position Summary:

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

Job Requirements

Duties:

• Develops project timelines, including short and long-term plans, key milestones, assignment of duties to each project plan work team member, and project “go-live” dates.
• Utilizes recommended and supported processes, standards, and tools to manage projects from inception through implementation to post implementation review and service transition.
• Ensures that projects are well planned, maintained, and communicated.
• Manages and is accountable for funded projects to ensure projects are completed within budgetary guidelines.
• Escalates issues that impact timing or budget to management and works with members of the project team to solicit additional team resources as needed during the project lifecycle
• Assembles project plan work team members from key stakeholder departments, and general support departments (e.g., IT, Finance, HR, etc.), assigns and delegates assignments to team members, and works to develop a team focused collaborative work environment of shared and individually assigned accountability.
• Evaluates and plans for all new projects from a lens of performance improvement and greater efficiencies.
• Adjusts schedules and targets on projects as needs, priorities, objectives, and/or financing changes.
• Performs quality control on projects throughout development to maintain the standards expected.
• Partners with project work team and non-work team clients/customers, technical staff, and management to effect successful projects and effective re-engineering of existing processes to support greater efficiencies and new initiatives.
• Provides, facilitates timely and effective transition of completed projects to client department staff for the ongoing administration of projects and initiatives.
• Consistently demonstrate behaviors, conduct and communications that support Meritage’s Practices and Values of Accountability, Diversity, Integrity and Respect for others, and seeks to influence these behaviors in others.
• Continuously endeavors to “raise the bar” of performance and teamwork through a focus on Innovation, Collaboration, Equality and
• Models professional work standards and behaviors to maintain and strengthen a professional working atmosphere and strictest confidentiality within the department and with other Meritage internal and external customers and work partners.
• Is accountable for work performed by self, works to develop and maintain trusting working relationships with others, and seeks to continuously learn from errors and experiences, as well as new developments in job specific administration and operational areas.
• Adopts, incorporates, is mindful of, and otherwise supports Meritage’s overarching annual and longer-term strategic business goals and objectives while performing work duties, special projects and other duties as assigned within or outside of Performance Improvement.
• Performs other than normally assigned duties and projects, as directed, and required, within and outside of Performance Improvement to support Meritage’s overall business needs, goals, and objectives.

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Job Description

Location: Novato, CA

Employment Status: Full Time

As a key member of the Network Relations Department, this position serves as a liaison for assigned geographic regions between Meritage and networked physician offices, traveling to and handling matters including but not limited to:

• Providing orientation on the Meritage Medical Network for new network providers and their office staff, including an overview of Meritage staff, resources, procedures, services, and applicable contact information
• Introduction, overview and explanation of new and existing Meritage services and programs available to network providers
• Provides initial and ongoing (i.e. monthly or quarterly), education and training to providers and their staff on accessing Meritage services and programs, policies and procedures, and updates and changes to the network

Maintains a regular and ongoing presence at the physician offices to build and maintain strong, trusting and professional working relationships with providers, practice managers and office staff.  Helps Meritage better understand the needs of the physician offices in order to develop new and effective strategies to support their success.  Spends approximately 1-2 days per week working in the field with network provider offices and 3-4 days at the Meritage office planning and preparing for site visits; however, this allocation of time in the provider offices and at Meritage is subject to change based on work volume, provider needs and business objectives.

PLEASE NOTE: Given current safety guidance due to the COVID19 pandemic the presence required in the physician office is remote.

Duties and Responsibilities

1. Maintains a sound and comprehensive understanding of all Meritage services and staff and how they support network physicians in order to serve as an effective and credible Meritage representative to those practices.
2. Develops physician/provider and office staff information and education materials for distribution in the field.
3. Works to ensure that the Meritage name and brand is present and visible in network practice offices to underscore and support the relationship between Meritage and the practice to office staff and patients.
4. Involved in development and coordination of updates and dissemination of the Network Quarterly newsletter to physician practices.
5. Participates in the preparation, coordination and hosting of network physician social events such as the annual mixer as well as Practice Manager social events.
6. Coordinates Regional Operations Committees and Membership Committee meetings, including but not limited to developing and maintaining committee lists, developing and sending out invitations, save the date reminders, reserving meeting locations, meal coordination, developing and disseminating meeting agendas and materials, taking and disseminating meeting minutes, and maintaining all records and associated databases.
7. Assists onboarding new member physicians and guides them and the practice staff through the Membership process. Ensures all documentation is collected, working closely with the Credentialing Coordinator.  Dispersing member physician contracts and getting signatures.
8. Tracks and monitors ongoing provider issues.
9. Regularly gathers data from practices on matters and topics such as physician satisfaction, patient access, service needs and requests that would help the practice be more successful.
10. Serves as a primary liaison between network physicians and their office staff, and Meritage representatives in the Utilization Management, Claims, Care Management, QA, Contracting and administration for the provision of service, education and training and problem resolution.
11. Makes recommendations to Meritage leadership regarding ways that the organization could be a better and more valued resource and partner to network providers and the staff.
12. Performs other duties as assigned related to supporting the Network Relations Department and the overall Meritage organization.

Job Requirements

Minimum Requirements and Competencies:

1. Strong demonstrated customer services skills and commitment.
2. Strong organizational skills with an attention to detail and the ability to multitask and juggle multiple priorities effectively.
3. Demonstrated excellent written and verbal communications skills, with ability to prepare and present effective individual and group presentation materials.
4. Professional demeanor and work style that projects a confident, open, capable, and trustworthy persona that is able to be sustained and maintained in all initial and subsequent interactions with customers and community representatives.
5. Ability to confidently and clearly present information in a large group setting.
6. Must possess strong listening skills with the ability to make the customer feel as though s/he has been heard and that his/her input, concerns and suggestions are valued and will be taken seriously.
7. Working knowledge, experience and expertise with office-based computer equipment and systems including but not limited to: Word, Excel, PowerPoint, Outlook, as well as other medically related databases and software applications.
8. 3-5 years’ experience working with physician and physician practices, their staff and affiliated businesses, e.g., 3^rd party suppliers and vendors, insurance companies, etc.
9. Bachelor’s degree in a related healthcare or business field with 3 years directly related work experience; or equivalent combination of education and work experience. Healthcare related sales training and/or experience is a plus.
10. Ability to exercise and be accountable for independent judgement and decision making on organizational and network issues
11. Upon hire, must provide a current Driver License and proof of insurance.

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Job Description

Location: Novato, CA (onsite)

Employment Status: Full-time

General Summary

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

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

Key Responsibilities

• Supports the HR Business Partner team with HR functional area efforts, projects and initiatives.
• Maintains a high level of confidentiality with sensitive Human Resources matters and materials.
• Coordinates the completion of pre-employment and new hire paperwork e.g., background checks, I-9 forms, and benefit enrollment.
• Coordinates the Exit Interview process and documentation for employees leaving the company.
• Assists with the tracking and reporting of HR related metrics including but not limited to hiring activity, terminations and turnover, employee demographics, training a development efforts for staff, employee service, and other HR related programs and services.
• Assists with the coordination and tracking of staff Leaves of Absences, consistent with FMLA, CFRA, ADA, and all other regulatory laws, rules, and requirements.
• Utilizes the company HRIS and assists with input and regular audit of employee data – demographics, assignment, and benefits data. Maintains excellent working knowledge of the HRIS and continues to develop more advanced skills in this area.
• Updates employee electronic files and databases to document personnel actions.
• Is accountable for work performed, works to develop, and maintain trusting working relationships with Meritage staff, HR co-workers, leadership, and external business partners.
• Seeks to continuously learn from errors and experiences, as well as new developments in job specific HR areas, and actively applies continuous performance improvement methods to workflows and processes.
• Performs other than normally assigned duties, as required, within and outside of the HR department to support Meritage’s business needs.
• Adopts, incorporates, is mindful of, and otherwise supports Meritage’s overarching annual and longer-term business goals and objectives while performing regular job responsibilities, special projects and other duties as assigned.

• Consistently demonstrate behaviors, conduct and communications that support Meritage’s Practices and Values of Accountability, Diversity, Integrity and Respect for others, and seeks to influence these behaviors in others.
• Continuously endeavors to “raise the bar” of performance and teamwork through a focus on Innovation, Collaboration, Equality and Compassion.

Job Requirements

Education and Knowledge, Skills and Abilities

Required

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

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Job Description

Location: Novato , California

Employment Status: Full-Time

Position Summary

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

Duties and Responsibilities

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

Job Requirements

Skills and Requirements

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

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

 Qualifications

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

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Job Description

Location: Novato, 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: Fresno, CA

Employment Status: Full Time

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

Principal Accountabilities:

Reaches out to patients identified as appropriate to provide information and education in order to deepen their understanding of their medical condition and to guide the patient in self-management of the chronic

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

organization’s operational needs.

Qualifications:

• Current California RN License with no restrictions and a minimum of 5 years clinical experience, previous case/care management experience is
• Associates in Nursing or comparable healthcare-related degree with an RN license. Coleman model trained is a plus.

Job Requirements

Requirements:

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

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Job Description

Location: Novato California

Employment Status: Full Time

As a key member of the Network Relations Department, this position serves as a liaison for assigned geographic regions between Meritage and networked physician offices, traveling to and handling matters including but not limited to:

• Providing orientation on the Meritage Medical Network for new network providers and their office staff, including an overview of Meritage staff, resources, procedures, services, and applicable contact information
• Introduction, overview and explanation of new and existing Meritage services and programs available to network providers
• Provides initial and ongoing (i.e. monthly or quarterly), education and training to providers and their staff on accessing Meritage services and programs, policies and procedures, and updates and changes to the network

Maintains a regular and ongoing presence at the physician offices to build and maintain strong, trusting and professional working relationships with providers, practice managers and office staff.  Helps Meritage better understand the needs of the physician offices in order to develop new and effective strategies to support their success.  Spends approximately 1-2 days per week working in the field with network provider offices and 3-4 days at the Meritage office planning and preparing for site visits; however, this allocation of time in the provider offices and at Meritage is subject to change based on work volume, provider needs and business objectives.

PLEASE NOTE: Given current safety guidance due to the COVID19 pandemic the presence required in the physician office is remote.

Duties and Responsibilities

1. Maintains a sound and comprehensive understanding of all Meritage services and staff and how they support network physicians in order to serve as an effective and credible Meritage representative to those practices.
2. Develops physician/provider and office staff information and education materials for distribution in the field.
3. Works to ensure that the Meritage name and brand is present and visible in network practice offices to underscore and support the relationship between Meritage and the practice to office staff and patients.
4. Involved in development and coordination of updates and dissemination of the Network Quarterly newsletter to physician practices.
5. Participates in the preparation, coordination and hosting of network physician social events such as the annual mixer as well as Practice Manager social events.
6. Coordinates Regional Operations Committees and Membership Committee meetings, including but not limited to developing and maintaining committee lists, developing and sending out invitations, save the date reminders, reserving meeting locations, meal coordination, developing and disseminating meeting agendas and materials, taking and disseminating meeting minutes, and maintaining all records and associated databases.
7. Assists onboarding new member physicians and guides them and the practice staff through the Membership process. Ensures all documentation is collected, working closely with the Credentialing Coordinator.  Dispersing member physician contracts and getting signatures.
8. Tracks and monitors ongoing provider issues.
9. Regularly gathers data from practices on matters and topics such as physician satisfaction, patient access, service needs and requests that would help the practice be more successful.
10. Serves as a primary liaison between network physicians and their office staff, and Meritage representatives in the Utilization Management, Claims, Care Management, QA, Contracting and administration for the provision of service, education and training and problem resolution.
11. Makes recommendations to Meritage leadership regarding ways that the organization could be a better and more valued resource and partner to network providers and the staff.
12. Performs other duties as assigned related to supporting the Network Relations Department and the overall Meritage organization.

Minimum Requirements and Competencies:

1. Strong demonstrated customer services skills and commitment.
2. Strong organizational skills with an attention to detail and the ability to multitask and juggle multiple priorities effectively.
3. Demonstrated excellent written and verbal communications skills, with ability to prepare and present effective individual and group presentation materials.
4. Professional demeanor and work style that projects a confident, open, capable, and trustworthy persona that is able to be sustained and maintained in all initial and subsequent interactions with customers and community representatives.
5. Ability to confidently and clearly present information in a large group setting.
6. Must possess strong listening skills with the ability to make the customer feel as though s/he has been heard and that his/her input, concerns and suggestions are valued and will be taken seriously.
7. Working knowledge, experience and expertise with office-based computer equipment and systems including but not limited to: Word, Excel, PowerPoint, Outlook, as well as other medically related databases and software applications.
8. 3-5 years’ experience working with physician and physician practices, their staff and affiliated businesses, e.g., 3^rd party suppliers and vendors, insurance companies, etc.
9. Bachelor’s degree in a related healthcare or business field with 3 years directly related work experience; or equivalent combination of education and work experience. Healthcare related sales training and/or experience is a plus.
10. Ability to exercise and be accountable for independent judgement and decision making on organizational and network issues
11. Upon hire, must provide a current Driver License and proof of insurance.

Job Requirements

Minimum Requirements and Competencies:

1. Strong demonstrated customer services skills and commitment.
2. Strong organizational skills with an attention to detail and the ability to multitask and juggle multiple priorities effectively.
3. Demonstrated excellent written and verbal communications skills, with the ability to prepared and present effective individual and group presentation materials.
4. Professional demeanor and work style that projects a confident, open, capable, and trustworthy person that is able to be sustained and maintained in all initial and subsequent interactions with customers and community representatives.
5. Must possess strong listening skills with the ability to make the customer feel as though s/he has been heard and that his/her input, concerns, and suggestions are valued and will be taken seriously.
6. Working knowledge and experience with office-based computer equipment and systems including but not limited to Word, Excel, PowerPoint, Outlook, as well as other medically related databases and software applications.
7. 3-5 years experience working with physician and physician practices, their staff, and affiliated businesses, e.g., 3^rd party suppliers and vendors, insurance companies, etc.
8. Bachelor’s degree in related healthcare or business field with 3 years directly related work experience; or equivalent combination of education and work experience. Healthcare-related sales training and/or experience is a plus.
9. Ability to exercise and be accountable for independent judgment and decision making on organizational and network issues
10. Upon hire, must provide a current Driver’s License and proof of insurance.

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Job Description

Location: Novato, California

Employment Status: Full-time

General Statement of Duties

The Senior Accountant prepares consolidated financial statements including balance sheets, income statements, and cash flow statements. Reviews and analyzes account balances, verifies accuracy, prepares reconciliations and other supporting schedules, investigates issues and makes recommendations for corrections. Develops and enhances accounting/finance applications and reports based on management needs for performance measurement. Provides guidance, assistance and back-up to other accounting and support staff as required/assigned, including revenue, accounts receivable/payable, payroll, and provider compensation.

Job Requirements

Education, Experience and Qualifications

• Bachelor’s degree in accounting. CPA or CPA-ready is preferred or a combination of experience and education.
• Minimum 5 years of current professional hands-on accounting experience including 3-5 years in a health care organization, managed care environment preferred. Additional experience with accounts payable and payroll is a bonus.
• Ability to work at an advanced level with Excel and accounting applications (Microsoft Dynamics Business Central, Great Plains or similar).
• Ability to perform mathematical computations and compute ratios and percentages.
• Skill in defining problems, collecting data, interpreting financial material.
• Skill in preparing statistical and narrative accounting and auditing reports
• Ability to communicate clearly and to maintain effective working relationships.

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Job Description

Location: Novato, CA - Remote

Employment Status: Full Time

The Network Relations Coordinator is responsible for performing numerous clerical and coordination support functions within the Network Relations Department.  A strong focus will be on database maintenance, including initial set-up and entry of data elements, data imports, as well as ongoing maintenance and regular auditing of information maintained in multiple systems.  Will work on various Network and Provider lists, rosters, fee schedules, contract templates, and related records and documents. Accountable for the integrity and quality of data maintained and works to resolve discrepancies through collaboration with co-workers and customers within and outside of the Network Relations department. Heavy emphasis on data management.

SUMMARY OF RESPONSIBILITIES

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

• Is accountable for work performed, works to develop, and maintain 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 applies continuous performance improvement methods to workflows and processes.
• Performs other than normally assigned duties, as required, within and outside of 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

Competencies

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

MINIMUM REQUIREMENTS

• Bachelor’s Degree with two (2) or three (3) years related experience and/or training or equivalent combination of education and experience
• Strong detail orientation and organizational skills.
• Effective written, verbal and listening communication skills.
• Ability to learn and utilize company systems, i.e., Quick Cap
• Proficient with MS Office (Word, Excel and Access), Outlook and Internet, FTP sites and downloading of files.

WORK ENVIRONMENT

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

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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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