Value Based Care Representative
On-siteHigh Point, North Carolina, United States
Job Summary
Design and implement innovative performance improvement strategies for practices using VBC reporting on HEDIS/STARS quality, HCC/RAF coding, cost, and utilization data. Collaborate with medical leadership to understand barriers to closing quality care gaps and interpret information from internal, ACO, and third-party payer sources to create comprehensive performance visualizations. Apply knowledge of healthcare systems, operations, and technology to maximize data impact through direct-to-provider interventions, education, and workflow enhancements. Manage administrative duties as workload necessitates while maintaining company confidentiality. Requires 2+ years of health industry experience, proficiency in EMRs and data analysis tools, and experience with Value-Based Care programs. Full-time role reporting to the Manager of VBC and COO at Bethany Medical's High Point Corporate Office.
Required Qualifications
- Experience with Value-Based Care programs
- 2+ years of experience in the health industry
- 2+ years of experience working with medical professionals
- Proficient computer skills, including Word and Excel spreadsheets, data entry, electronic medical record (EMR) / Practice Management (PM) systems, and analysis tools
- Excellent communication skills with the ability to work collaboratively with physicians, staff, and external organizations
- Strong phone skills, comfortable with patient engagement
- Strong customer service skills
- Ability to manage multiple tasks/projects simultaneously
- Comfortable with continuous change and self-initiating
- Use conflict resolution skills when reaching consensus about plans of care and treatment decisions
- A bachelor's degree in a related field
- Certified Medical Assistant certificate
- RNs
Desired Qualifications
- care gap management
- coding
- clinical experience
- provider relations
- value-based care
- Organized and self-motivated
- Uses strong attention to detail, advanced problem-solving, and complex reasoning to effectively produce change and demonstrate impact
- Performs administrative duties as workload necessitates
- Possess a working knowledge of healthcare coding (ICD 10, CPT codes, etc.)
- Demonstrates strong knowledge of provider workflows and practice performance
- Maintains company confidentiality in all areas
- Uses superior communication skills- Speaks effectively in all environments; listens, requests clarification, and responds well to feedback
- Demonstrates flexible and efficient time management and ability to prioritize workload
- Possess a strong knowledge of health care models, including ACOs
- Uses VBC reporting on HEDIS/STARS quality, HCC/RAF coding, healthcare service cost and utilization, patient steerage patterns, etc., to design and implement innovative performance improvement strategies for practices and providers
- Collaborates with the medical leadership team to understand barriers to closing quality care gaps and effectively coding for services performed
- Interprets information from multiple data sources (internal, ACO, and third-party payer) to create a comprehensive performance visualization
- Applies knowledge of healthcare systems, operations, program design and implementation, technology, and innovation to maximize data impact
- Collaborative team-first attitude, transparently sharing ideas and data
- Works well within a team atmosphere, flexible to pivot in approach
- Demonstrates proficient computer skills, including EMRs
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