Insurance & Value Based Care Specialist | Community Health Center

Responsibilities

• Work with the Director to understand, precisely document, and prioritize all value-based contract requirements, and then organize these requirements into a coherent roadmap that outlines key activities and milestones.
• Use available data and best practices to develop creative and innovative strategies, interventions, and other performance improvement strategies in collaboration with health center members.
• Track payer payments and escalate issues as necessary to the Director.
• Prepare and present progress against goals monthly to Director.
• Provide project coordination, analytical reporting, and operational support for increasing access to health services with/for an identified population through the health centers’ care management team.
• Increase access to health services with/for an identified population through the health centers’ Clinic Leadership team as directed by Director.
• Develop, maintain, share, and educate stakeholders on complex analytical models supporting data literacy.
• Lead practice transformation and practice performance improvement initiatives.
• Guide Health Centers in achieving targeted goals and outcomes, to improve quality, efficiency, and utilization.
• Analyze cost, utilization, and quality data from multiple data sources, including, but not limited to, payer portals and payer claims.
• Establish relationships, gather input, and facilitate communication amongst key stakeholders.
• Use data dashboards to educate and foster opportunities for change in clinical workflow.
• Review monthly practice team reports and facilitate improvement strategies.
• Verify insurance information for all appointments.
• Update insurance information in EHR for all appointments.
• Update utilization of billing codes in EHR to ensure health center optimizes Value-Based Care programs.

Qualifications

• Bachelor’s degree either in health care administration, nursing, business management, public health, or another health-related field preferred.
• A person not possessing a bachelor's degree may be considered if their combination of education and experience matches what is needed for this role.
• Knowledge of CPT codes and basic medical terminology (preferred).
• Value-Based Care experience.
• Phone communication skills.
• Bilingual ability (English/Spanish).