Base: $79,300.00 - $127,100.00; bonus/equity: not ...
Hybrid
Medicare stars sme
Medicaid hedis sme
Risk revenue streams expertise
This job is directly responsible for value creation, impact, cost control, and fiscal/ROI targets, including revenue stream outcomes and engagement of primary care providers (PCP) in government value-based reimbursement programs
Job Summary
This job is directly responsible for value creation, impact, cost control, and fiscal/ROI targets, including revenue stream outcomes and engagement of primary care providers (PCP) in government value-based reimbursement programs.
The Medicare Advantage Quality Consultant is responsible for collaborative work with other functions in the provider area, data analytics, and key internal/external stakeholders to provide the most appropriate support to PCPs based upon data analysis and dashboard reports.
Directly responsible to provide office based, hands-on assistance services (i.e., chart reviews, mass claims adjustments, UDC processes, etc.) to PCPs enrolled in Medicare STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.
Matching Summary
This job is directly responsible for value creation, impact, cost control, and fiscal/ROI targets, including revenue stream outcomes and engagement of primary care providers (PCP) in government value-based reimbursement programs.
Salary
Base: $79,300.00 - $127,100.00; Bonus/Equity: Not specified; Benefits: Not specified
Skills & Requirements
Must-have
Medicare STARS SME
Medicaid HEDIS SME
Risk revenue streams expertise
Value-based reimbursement programs
Provider performance analysis
Strategic plan development
Nice-to-have
Lean, Six Sigma, TQI, TQC experience
Provider network performance management
Population health management
Continuous improvement methodologies
Provider engagement models
Key Requirements
Bachelor's Degree in clinical or healthcare related field or 6 years of relevant experience
5 years Medicare/Medicaid and risk revenue experience
3 years data analysis and strategic plan development
Experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams