Description:
GENERAL SUMMARY
Responsible for health plan Medicare revenue improvements and strategy. Responsible for project management of the STARS program; establishes standards that are compatible with industry, regulatory, and public health requirements. Also responsible for the daily management of the health plan’s Medicare Risk Adjustment program, strategizing where additional resources or focus needs to be directed to maximize outcome. Identifies and recruits physicians to actively participate in the program.
ESSENTIAL RESPONSIBILITIES
-- Serves as health plan project lead on STARS program, including member satisfaction activities. Works to close data and performance gaps. Drives member perception imiprovement.
-- Provides oversight and direction to the Medicare Risk Adjustment program. Identifies issues which may adversely impact the attainment of goals and initiatives. Develops and implements corrective action plans as necessary.
-- Identifies and recruits physicians and provider group practices to participate in the Medicare Risk Adjustment/STARS exchange. Develops and maintains relationships with current program participants. In collaboration with other departments, delivers training and education on Medicare Risk Adjustment, accurate coding, and STARS opportunities.
-- Communicates results and recommendations to project sponsors. Assists in strategizing and developing action plans. Coordinates team/project activities, schedules, and facilitates meetings. Develops and refines methodology on process and outcome measurement. Seeks out normative data, benchmarks, etc. for comparative purposes. Makes formal presentations.
-- Develops policies, procedures, and guidance on data quality and standardization. Develops modeling specifications for revenue improvement opportunities including reconciling relevant databases to assure consistency, tracing down data gaps, and/or reviewing contract requirements. Conducts economic and data impact analysis on proposed or new regulations.
-- Researches, designs, and assists in constructing parameters in performance measurements consistent
with the company’s strategic direction in revenue, STARS, and risk identification.
-- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
-- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
-- Bachelor’s degree or equivalent experience. Master’s degree preferred.
-- Previous (3-5 years) experience in HEDIS/CMS Stars and/or Medicare Risk Adjustment.
-- Previous (3-5 years) experience working in physician billing and/or Practice Administration.
-- Strong communication, presentation, analytical, and negotiation skills required.
-- Demonstrated ability to conduct and interpret quantitative and qualitative analysis.
-- Demonstrated ability to navigate among economic, clinical, research, and technology.
-- Understanding of CMS risk model.
-- Knowledge of Medicare/CMS regulations highly desired.
-- Knowledge of ICD-9 and CPT codes highly desired.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: First/Mid Level Officials and Managers
Primary Location: Overland Prk, KS, US
Other Locations: ,
Organization: 13000 - CHC of Kansas
Schedule: Full-time
Job Posting: 2013-04-26 00:00:00.0
Job ID: 1311574
GENERAL SUMMARY
Responsible for health plan Medicare revenue improvements and strategy. Responsible for project management of the STARS program; establishes standards that are compatible with industry, regulatory, and public health requirements. Also responsible for the daily management of the health plan’s Medicare Risk Adjustment program, strategizing where additional resources or focus needs to be directed to maximize outcome. Identifies and recruits physicians to actively participate in the program.
ESSENTIAL RESPONSIBILITIES
-- Serves as health plan project lead on STARS program, including member satisfaction activities. Works to close data and performance gaps. Drives member perception imiprovement.
-- Provides oversight and direction to the Medicare Risk Adjustment program. Identifies issues which may adversely impact the attainment of goals and initiatives. Develops and implements corrective action plans as necessary.
-- Identifies and recruits physicians and provider group practices to participate in the Medicare Risk Adjustment/STARS exchange. Develops and maintains relationships with current program participants. In collaboration with other departments, delivers training and education on Medicare Risk Adjustment, accurate coding, and STARS opportunities.
-- Communicates results and recommendations to project sponsors. Assists in strategizing and developing action plans. Coordinates team/project activities, schedules, and facilitates meetings. Develops and refines methodology on process and outcome measurement. Seeks out normative data, benchmarks, etc. for comparative purposes. Makes formal presentations.
-- Develops policies, procedures, and guidance on data quality and standardization. Develops modeling specifications for revenue improvement opportunities including reconciling relevant databases to assure consistency, tracing down data gaps, and/or reviewing contract requirements. Conducts economic and data impact analysis on proposed or new regulations.
-- Researches, designs, and assists in constructing parameters in performance measurements consistent
with the company’s strategic direction in revenue, STARS, and risk identification.
-- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
-- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
-- Bachelor’s degree or equivalent experience. Master’s degree preferred.
-- Previous (3-5 years) experience in HEDIS/CMS Stars and/or Medicare Risk Adjustment.
-- Previous (3-5 years) experience working in physician billing and/or Practice Administration.
-- Strong communication, presentation, analytical, and negotiation skills required.
-- Demonstrated ability to conduct and interpret quantitative and qualitative analysis.
-- Demonstrated ability to navigate among economic, clinical, research, and technology.
-- Understanding of CMS risk model.
-- Knowledge of Medicare/CMS regulations highly desired.
-- Knowledge of ICD-9 and CPT codes highly desired.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: First/Mid Level Officials and Managers
Primary Location: Overland Prk, KS, US
Other Locations: ,
Organization: 13000 - CHC of Kansas
Schedule: Full-time
Job Posting: 2013-04-26 00:00:00.0
Job ID: 1311574