Company Statement

Connecticare is a leading health plan in the state of Connecticut and a subsidiary of EmblemHealth, a health and wellness company that provides insurance plans, primary and specialty care, and wellness solutions.  WellSpark is a digital wellness company and national subsidiary of EmblemHealth that offers a full suite of products and solutions to reward people for healthy behaviors.

 

To protect the health and safety of our workforce, members, patients, and the communities we serve, the EmblemHealth family of companies require all new employees to be fully vaccinated for COVID-19. Exemption/reasonable accommodations may be granted because of 1) a qualifying medical condition or disability that makes getting the vaccine unsafe for the individual, or 2) objection on the basis of sincerely held religious beliefs and/or practices.
 

Sr. Provider Revenue Specialist

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Manager & Professional
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ConnectiCare
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Responsible for supporting the development and implementation of a comprehensive Clinical Documentation Improvement (CDI) risk adjustment and assist vendors and provider groups in Medical Chart Retrieval cycles.  Serve as a liaison between EmblemHealth 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. Identifying areas for improvement and routinely monitoring success of the risk adjustment provider engagement model. Drive member office visits with assigned region and reduce the number of non-users. Administrative duties as they relate to Provider Groups and to Risk Adjustment Vendors.


Responsibilities:

  • Manage the day to day activities involving the Provider and Vendor compliance functions for Emblem Medicare, Medicaid and Commercial 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 and disseminating provider communications, increasing the provider participation goals and other activities related to risk adjustment.
  • Oversee and manage annual chart review cycles across Emblem’s Medicare, Medicaid and Commercial members. Individual is responsible for working with their assigned providers, provider groups, delegates to aide Emblems vendors in operating within the current SLA standards.
  • Perform analysis of program critical success factors and identify opportunities for improvement to stratify existing outreach initiatives and identify new program opportunities. 
  • 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 (R)
  • Master’s Degree (P)
  • Driver’s License (R) 
  • Minimum four to six years’ experience, preferably in Healthcare, plan or provider operations and relations; other related experience may also be considered (R)
  • 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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