Senior Population Health Specialist

Overview

A challenging and rewarding opportunity awaits a Senior Population Health Specialist at Sante Health System in Fresno, CA. In collaboration with the department team, the Senior Quality Management Specialist will assist in facilitating Population Health program activities and operations. Provides complex administrative, project management, and operations support for various organization-critical initiatives, projects and processes within the Quality Management Department. Department activities span across various managed care lines of payer business including Medicare Advantage, HMO Commercial, and Accountable Care Organization (ACO) as well as various provider specialties and groups.

• Bachelor s degree
• Minimum of five (5) years of experience in one or more of the following:
• HEDIS measures
• Medicare Risk Adjustment
• Clinical office settings (primary care preferred)
• Demonstrated professional proficiency in the following competencies:
• Certified coding
• Interpretation of technical data specifications
• Critical thinking and analytical reasoning
• Microsoft Office:
  Excel, Word, Outlook, Power Point
• Problem-solving and root-cause analysis
• Research and data validation
• Project management
• Statistical concepts and basic analysis
• Electronic Medical Records (EMR), Practice Management systems, and data aggregation software
• Effective verbal and written communication
• Presentation and communication 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
• Educates and advises provider and/or office staff on the proper use of CPT II Coding for data capture
• Educates and advises provider and/or office staff on the use of the data aggregator software and how to incorporate its functions into the office workflow
• Supports all P4P and CMS Medicare STARS and RAF initiatives and processes
• Assists in the Retrieval of Information (ROI) process 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
• Maintain strictest confidentiality
• In the spirit of teamwork, employees are expected to follow any other job-related instructions and to perform any other job-related duties as requested

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 Health System provides numerous client services such as billing, claims processing, contracting, credentialing, finance, human resources, information services, marketing/communications, physician services, practice management, provider relations, quality improvement, and utilization management.

Sante is celebrating over 30 years of service to the community. We deeply understand that we would not be successful in enhancing the quality of life of our patients without our incredible team. We provide competitive pay, excellent benefits including medical, dental, vision, and life insurance, 401k retirement plan, paid time off, and opportunities for advancement. Being part of our team is like being part of a big family.

Join our team and make Sante Health System your home away from home.

We understand your time is valuable, so we have a very quick and easy application process. If you feel that you would be right for this job in health care, please fill out our initial 3-minute, mobile-friendly application. We look forward to meeting you!

Salary: $35.00 - $50.40 per hour