Senior Population Health Specialist

Sante Health•Fresno, CA

1d•Onsite

About The Position

A challenging and rewarding opportunity awaits a new Senior Population Health Specialist at Sante Health System in Fresno, CA. In collaboration with the department team, the Senior Quality Management Specialist will assist in facilitating Population Health program activities and operations. Providing complex administrative, project management, and operations support for various organization-critical initiatives, projects and processes within the Quality Management Department. Department activities span across various managed care lines of payer business including Medicare Advantage, HMO Commercial, and Accountable Care Organization (ACO) as well as various provider specialty and groups. The Senior Quality Management Specialist supports the various programs' educational objectives and effectively interfaces with clinical partners to successfully monitor and improve electronic medical record efficacy, with a primary focus on Hierarchical Condition Category (HCC) capture rates, Healthcare Effectiveness Data and Information Set (HEDIS), Quality Performance Initiative Program and Medicare STARS quality measures.

Requirements

Bachelor's degree
Minimum of five (5) years of experience in one or more of the following:
HEDIS measures
Medicare Risk Adjustment
Clinical office settings (primary care preferred)
Demonstrated professional proficiency in the following competencies:
Certified coding
Interpretation of technical data specifications
Critical thinking and analytical reasoning
Microsoft Office: Excel, Word, Outlook, Power Point
Problem-solving and root-cause analysis
Research and data validation
Project management
Statistical concepts and basic analysis
Electronic Medical Records (EMR), Practice Management systems, and data aggregation software
Effective verbal and written communication
Presentation and communication skills
Proficient technical skills with MS Office (Excel, Word, Outlook and PowerPoint)
Good organization, analytical, interpersonal, and strong communication skills.
Experience and expertise with medical practice management software, knowledge of various EMR systems is a plus.

Responsibilities

Provides administrative support to ensure success of IPA's Medicare Risk Adjustment, HEDIS and CMS STARS initiatives.
Educates and advises provider and/or office staff on program initiatives.
Educates and advises provider and/or office staff on the proper use of CPT II Coding for data capture.
Educates and advises provider and/or office staff on the use of the data aggregator software and how to incorporate its functions into the office workflow.
Supports all P4P and CMS Medicare STARS and RAF initiatives and processes.
Assists in the Retrieval of Information (ROI) process for participating health plans, and Santé Foundation Medical Group providers where access is available.
Presents information and responds to questions from clinic sites, members, internal staff, vendors, and health plan representatives.
Prepares and presents reports as requested.
Identifies process issues and make recommendations for improvement.
Provides varied administrative and project management support within the Quality Management department.
Participates in health plan and department team meetings as needed.
Works with other departments and health plans to identify and collect data for reporting and department communications.
Maintain strictest confidentiality.
In the spirit of teamwork, employees are expected to follow any other job-related instructions and to perform any other job-related duties as requested.