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Payer Program Specialist - Care Management

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Job ID: 4502
Location: Bellingham, WA
Work Type: Full Time
Shift: Day
Shift Length: 9 Hours
FTE: 1.00
Benefit Eligibility: Full-time benefits

Job Description

Description

PeaceHealth is seeking a Payer Program Specialist - Care Management for a Full Time, Day position.  Hourly compensation starts at $18.99, more depending on experience.

JOB SUMMARY

Responsible for the analysis, communication and dissemination of data for population health management purposes. Works with population health management staff to support the clinical and division strategic priorities. Collaborates with internal departments, clinical teams and external organizations to ensure the availability of timely and accurate information upon which population health management program decisions will be made.

ESSENTIAL FUNCTIONS

  1. Performs statistical and data analysis, benchmark determination, goal setting, written and graphical reports and data presentations of data for population health management programs (HEDIS, Medicare STARS, CCO metrics, quality management/improvement).
  2. Ensures process and formation flow of all population health data. Analyzes impact of data on various quality improvement projects or programs.
  3. Performs gap analysis of current systems to determine compliance with data reporting requirements.
  4. Collaborates with other departments as necessary to conduct and complete analyses.
  5. Attends internal and external meetings to present analyzed data.
  6. Coordinates work associated with payer incentive agreements and delegates to other staff as needed.
  7. Serves as liaison between payer incentive (vendor or provider) and PeaceHealth.
  8. Facilitates payer incentive payments and ensures they are received.
  9. Performs outreach work to patients on risk stratified health plans to coordinate care services
  10. Performs other work as assigned.

QUALIFICATIONS

EDUCATION:

  • Bachelor’s degree in health care administration, or related field of study preferred.

EXPERIENCE/TRAINING:

  • Three years’ experience in a healthcare or health insurance setting performing registration, back office support, care management, quality or health analysis required.
  • Experience and/or training in revenue cycle (health insurance plans and benefits structures) preferred.

LICENSE/CERTIFICATION:

  • Completion of technical training/certification in a related field (such as Certified Medical Assistant), preferred.

OTHER SKILLS:

  • Proficient use of computers including Microsoft Office applications including Excel, Access and Word.
  • Proficient in working with spreadsheets, querying data, generating reports and developing/delivering presentations.
  • Detail oriented and ability to think analytically and perform data analysis.
  • Excellent communication skills, both verbal and written.
  • Ability to prioritize and coordinate multiple tasks at once.
  • Ability to work effectively within a self-directed teamwork environment.

PHMG PHYSICAL / COGNITIVE REQUIREMENTS 

  • Work requires normal amounts of physical effort up to 33% of the time and constant sitting
  • Ability to lift objects weighing 25 lbs or less.
  • Work is performed under normal working conditions with adequate lighting and ventilation.
  • Duties require the ability to concentrate and pay close attention to detail up to 100% of the time.

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility.

For full consideration of your skills and abilities, please attach a current resume with your application.  EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.  

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