Population Health Specialist

NOT A REMOTE POSITION. A challenging and rewarding opportunity awaits!

Sante Health System in Fresno, CA is looking to hire a Full Time Population Health Specialist in Fresno, California. In collaboration with the department team, the Population Health Specialist will assist in facilitating Population Health program activities and operations. The Population Health Specialist supports the various programs  educational objectives and interfaces with clinical partners to monitor and improve electronic medical record efficacy, with a primary focus on Hierarchical Condition Category (HCC) capture rates, Healthcare Effectiveness Data and Information Set (HEDIS), Quality Performance Initiative Program and Medicare STARS quality measures.

• Provides administrative support to ensure success of Medicare Risk Adjustment, HEDIS and CMS STARS initiatives.
• Educates and advises provider and/or office staff on program initiatives.
• Assists in the retrieval of information (ROI) for participating health plans, and Santé Foundation Medical Group providers where access is available.
• Presents information and responds to questions from clinic sites, members, internal staff, vendors, and health plan representatives.
• Prepares and presents reports as requested.
• Identifies process issues and makes recommendations for improvement.
• Provides varied administrative and project management support within the Quality Management department.
• Participates in health plan and department team meetings as needed.
• Works with other departments and health plans to identify and collect data for reporting and department communications.
• Other functions and accountabilities may be assigned.

• Minimum 3-5 years of previous experience with HEDIS measures
• Medicare Risk Adjustment, or experience in a clinical office setting, primary care preferred
• Valid California Driver s License due to required travel to different physician offices
• Demonstrated ability in the following skill set:
  • Certified Coder (preferred)
  • Interpretation of technical data specifications
  • Critical thinking
  • Excel spreadsheet use
  • Problem-solving
  • Research
  • Project management
  • EMR and data aggregator software
  • Communication, verbal and written
  • Presentation skills

Knowledge, Skills & Abilities

• Proficient technical skills with MS Office (Excel, Word, Outlook and PowerPoint)
• Good organization, analytical, interpersonal, and strong communication skills
• Experience and expertise with medical practice management software, knowledge of various EMR systems is a plus

• Provides administrative support to ensure success of IPA s Medicare Risk Adjustment, HEDIS and CMS STARS initiatives.
• Educates and advises provider and/or office staff on program initiatives.
• Assists in the retrieval of information (ROI) for participating health plans, and Santé Foundation Medical Group providers where access is available.
• Presents information and responds to questions from clinic sites, members, internal staff, vendors, and health plan representatives.
• Prepares and presents reports as requested.
• Identifies process issues and makes recommendations for improvement.
• Provides varied administrative and project management support within the Quality Management department.
• Participates in health plan and department team meetings as needed.
• Works with other departments and health plans to identify and collect data for reporting and department communications.
• Other functions and accountabilities may be assigned.

Sante Health System is a Management Services Organization that serves multiple clients. "Sante" is the French word for health. Our name symbolizes our commitment to good health, progressive care, and leadership in our community. Sante is one of the largest health care claims and billing management companies in Central California. The strength of Sante is the extraordinary network of physicians, health plans, and other health service providers it offers the people of our valley.

Sante coordinates with physicians, health plans, hospitals, and ancillary providers to ultimately benefit the patient in a managed care environment. Sante…