Responsible for the end-to-end performance of assigned HEDIS measures, with a primary focus on achieving and sustaining 5-Star performance.
Translate data and chart findings into actionable insights for providers, ensuring that care gaps are clearly identified and surfaced through tasks or alerts within clinical workflows.
Partner cross-functionally with data, clinical, and provider engagement teams to ensure accurate reporting, efficient workflows, and optimal performance.
Establish and monitor performance metrics to measure the reliability and latency of payer data feeds.
Serve as the primary point of escalation for high-priority payer data issues, coordinating with various teams.
Oversee the documentation and submission processes for clinical data extracts to ensure audit readiness.
Aledade empowers independent primary care practices to deliver better patient care and thrive in value-based care. As the largest network of independent primary care in the country, they focus on creating value-based contracts, strengthening care continuity, and aligning incentives to ensure physicians are paid for keeping patients healthy.
Monitor and interpret CMS, state Medicaid, and industry risk adjustment and quality regulations.
Provide SME guidance to Product, Sales, and Account Management on RA policy and program implications.
Partner with product teams to ensure solutions align with regulatory and audit requirements.
Cotiviti is a company that focuses on healthcare solutions. They offer a competitive benefits package to address a wide range of personal and family needs.
Own and maintain a centralized payer rulebook across all health plans.
Interpret payer requirements and translate them into clear operational workflows.
Own performance outcomes at the health plan level (KPIs, compliance, documentation).
Zócalo Health is a tech-enabled, community-oriented primary care organization serving people who have historically been underserved by the healthcare system. They partner with health plans, providers, and community organizations to deliver culturally competent care and are scaling rapidly across states and populations.
Identify areas for process improvement based on metric analysis findings.
Develop and disseminate action plans to correct knowledge gaps in CDI and Coding.
Collaborate on data reports for the Coding and CDI departments.
Cooper University Health Care's commitment to providing extraordinary health care begins with their team. They are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols and offer opportunities for career growth.
Responsible for planning and executing quality and oversight activities to ensure operational compliance.
Responsible for internal and external case audits for Capital and our delegated UM vendors.
Responsible for educating staff on findings, and the audit tool ensuring a consistent approach.
Capital Blue Cross promises to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”