Sr. Provider Revenue Specialist

📁
Manager & Professional
💼
EmblemHealth
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Responsible for supporting the development and implementation of a comprehensive Clinical Documentation Improvement (CDI) risk adjustment and provider outreach program to support Emblem provider groups / partnerships. Serve as a liaison between Emblem Health and Emblem’s Risk Adjustment vendors for efforts related to the Medical Record Review process; provider outreach submission of provider alerts; and provider education on proper coding and documentation. Oversee assigned provider offices and responsible for face to face provider engagement a minimum of 3-4 offices per week. Identifying areas for improvement and routinely monitoring success of the risk adjustment provider engagement model. 

Responsibilities:

  • Manage the day to day activities involving the Provider compliance functions for Emblem Medicare, Medicaid and QHP members. This will include, but is not limited to, managing the risk adjustment provider Clinical Documentation Initiative process, educating providers on the importance of complying with medical record requests, developing, presenting, and disseminating provider communications, and other activities related to risk adjustment.
  • Oversee and manage day-to-day activities involving Provider Engagement for Emblem’s risk adjustment program across Emblem’s Medicare, Medicaid and QHP members. This will include developing, implementing and reporting on all retrospective and prospective activities related to this book of business. 
  • Perform Chart review and analysis of provider activity around HCC conditions documented at DOS.
  • Coordinate and develop prospective operational strategies for participating providers including communication and incentive plans for the Provider Clinical Documentation Initiative, member outreach, and provider education including physician consultants and developing training programs for offices.  This includes electronic management of provider information for the purposes of targeted outreach. 
  • Project management including coordination of interdepartmental communications including Finance, Medicare and Actuarial and provide monthly updates on the progress of various projects, both operationally and financially. 

Qualifications:

  • Bachelor’s Degree in Healthcare, Finance or Business 
  • CRC certification preferred or in process of acquiring  
  • Master’s Degree, a plus but not required 
  • Driver’s License required  
  • Minimum four to six years’ experience, preferably in Healthcare, plan or provider operations and relations; other related experience may also be considered (R) 
  • Experience with EPIC EMR system 
  • Strong customer service experience (R) 
  • Ability to manage time and work efficiently to meet deadlines with minimal supervision 
  • Excellent written and oral communication skills to deliver complex information and achieve positive results 
  • Strong decision-making and problem-solving capabilities 
  • Capacity to Multi-task at high detail-oriented level (R) 
  • Strong working knowledge of MS office applications, specifically Excel, Access knowledge a plus (P) 
  • Solid analytical and logical skills paired with strong attention to detail (R) 

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