[Hiring] Risk Adjustment Project Coordinator I/II/III @company

Role Description

The Risk Adjustment Project Coordinator supports the risk adjustment initiatives for Excellus Health Plan.

• Review, monitor and track the medical record retrieval reports to identify provider issues such as refusals to comply with medical record requests.
• Initiate outbound phone calls to noncompliant providers to resolve provider refusal and/or concerns related to the Health Plan’s request for medical records.
• Build and maintain strong working relationships with providers and office staff.
• Educate providers of their contractual obligation to comply with Health Plan’s request in a professional manner to minimize provider abrasion.
• Directly negotiate with providers to procure scheduled commitment to deliver requested medical records, retrieval method, and payable fees for the medical records.
• Identify and escalate program-related issues to the Project Manager and/or Manager as appropriate.
• Identify patterns generated by external and internal actions affecting provider adherence as it relates to medical record requests.
• Communicate issues/findings to the Project Manager and appropriate team members.
• Responsible for collecting and scanning project-related documents and disbursing to the appropriate audience.
• Analyze, compile, and prepare retrieved medical records for transfer.
• Initiate Health Plan check requests for provider payments.
• Collaborate with various stakeholders to resolve provider issues related to medical record retrieval activities.
• Foster an environment of continuous improvement and encourage innovative thinking.
• Constantly explore ways to increase efficiencies and productivity, reducing waste, and reducing costs.
• Consistently demonstrate high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintain high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Perform other functions as assigned by management.

• Manage the respective risk adjustment failed quality assurance (QA) medical records reports through research and analysis.
• Monitor and report on the progress of the resolution of high impact problems according to established standards.
• Identify opportunities through trend analysis for improvement including non-compliant providers and medical recording targeting anomalies.
• Serve as designated liaison between special handle providers, including large provider groups and hospitals.
• Initiate communication with special handle providers of upcoming medical record requests campaigns.
• Directly negotiate with special handle providers to procure schedule commitment, payments, etc.
• Initiate requests for customized reports for special handle providers and deliver to the requestor.
• Perform daily data import to the Provider Issue Tracking database, assign provider escalation work items to the Project Coordinators.
• Act as a resource for team questions.
• Monitor and execute reports on provider escalation open inventory.
• Serve as the liaison and facilitator for member-related requests and/or inquiries relative to the prospective risk adjustment programs.

• Perform project management duties over small-tier risk adjustment or other initiatives as assigned.
• Drive medical record retrieval activities in support of risk adjustment programs.
• Work closely with Project Manager providing vendor oversight.
• Assist Project Manager to determine project schedules, deliverables, assignments, tasks, project meetings, status reporting, communication, and action items.
• Assist Project Managers and project teams to track work, tasks, and project assignments to keep projects on-time and within scope.
• Serve as backup for Project Manager as needed.

Qualifications

• Associate degree in Business Administration or related field required. In lieu of degree, High School Diploma and three years related work experience required.
• One year of related work experience required.
• Demonstrates ability to operate within shifting priorities, demands and timelines.
• Persuasive, encouraging, and motivating.
• Strong all-around soft skills and high level of proficiency using written and oral communication skills.
• Demonstrated problem-solving skills.
• Strong organizational skills and ability to prioritize, multi-task, and work in a fast-paced environment.
• Demonstrates technical proficiency in MS Teams, Outlook, Word, OneNote, and Excel.
• Knowledge of claims, provider, and membership systems.
• Demonstrates ability to work effectively as a member of a team.

• Four years related work experience is required.
• A relevant bachelor’s degree is preferred.
• Self-motivated; ability to take initiative and ownership.
• Interfaces effectively with all levels of management.
• Demonstrated analytical and business process development skills.
• In-depth knowledge of Health Plan Operations and/or Risk Adjustment Operations.
• Ability to maintain poise and composure under pressure and in difficult situations.

• Six years of related work experience is required.
• Strong meeting facilitation skills.
• Ability to create and manage project plans and schedules.
• Experience in drafting both internal and external communications to convey project findings and status.
• Adept at conducting research when project-related issues occur.
• Expert knowledge of Health Plan Operations and/or Risk Adjustment Operations.
• Experience drafting concise and informative communication pieces at the department and/or project team level.

Benefits

• Participation in group health and/or dental insurance.
• Retirement plan.
• Wellness program.
• Paid time away from work.
• Paid holidays.

Compensation Range(s)

• Level I: Grade N5: Minimum $20.02 - Maximum $33.03
• Level II: Grade N6: Minimum $21.83 - Maximum $34.92
• Level III: Grade N7: Minimum $23.56 - Maximum $37.70

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.