Population Health Specialist

Spectrum Health Services, Inc
Philadelphia, PA Full Time
POSTED ON 6/10/2022 CLOSED ON 9/21/2022

Job Posting for Population Health Specialist at Spectrum Health Services, Inc

Description

Job Details:

The Population Health Specialist will work as an integral part of an interdisciplinary team to support the goals and protocols of the health population workflow. The individual must be able to process large quantities of data to monitor key performance indicators and research all barriers to successful revenue cycle management. The candidate must possess the ability to work independently and interchangeably across all contracted health plans and workflows, with strong organizational, communication and interpersonal skills

Works in partnership with the Revenue Cycle Manager and Revenue Cycle Director to ensure all contracted health plan quality incentive measures and care gaps are reviewed, addressed, and strategically worked. Determines opportunities for improvement with regards to scheduling, claim submission and follow up, and health plan collaboration and event planning. Facilitates process improvement to affect change to achieve revenue cycle best practices. Ensure consistency and compliance throughout the Network


Essential Functions:

  • Collaborate with Director of Revenue Cycle Management in the planning, implementation, administration, and evaluation of health plan incentive and care gap measures that have the potential to increase revenue, improve service or efficiency, or results in cost reduction.
  • Communicates with personnel in all areas of Spectrum including attending departmental meetings.
  • Attend all insurance provider representative meetings as well as lead provider meetings when other leadership is not present or available.
  • Use of health plan portals and reporting tools to proactively identify patients due or over-due for specific health services (care gaps), contacts the patients, motivates the patient to complete the recommendation, and assists in scheduling appointments.
  • Obtains all necessary appointment information and assures patients are scheduled appropriately for evaluation, checking with clinical staff when necessary for guidance, annotating what services the patient is presenting for.
  • Monitor members to ensure that appointments are kept.
  • Strong customer service skills; answering client, patient and carrier calls; prompt return and follow up to all interactions; prompt response to requests for information.
  • Responsible for contacting new and established members identified on the health plan incentive/care gap reports and assures they are scheduled for appointments using appropriate EMR system (Athena & Dentrix).
  • With the Revenue Cycle Manager, research and process claims billing data, analyzing trends, and identifying areas for improvement. Communicate accordingly through prescribed avenues based on organizational policy and process.
  • Develop, process, and maintain ongoing emergency room diversion lists that Spectrum receives from our hospital partners including contacting patients identified on the lists and scheduling follow-up appointments.
  • Remain flexible and adapt to changing health plan regulations, incentive measures, and care gap protocols.
  • Provide all necessary reporting and data required by the Director of Revenue Cycle Management.


Requirements

Minimum Requirements:

  • Medical Terminology certification is preferred.
  • Billing and coding certification.
  • High School Diploma
  • Knowledge of the revenue cycle and how billing and coding effect revenue
  • Proficient with Microsoft Word and Excel
  • Comfort and flexibility working in a fast-paced health environment.
  • The ability to sit for the majority of the workday.
  • Proven track record of customer service skills


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