OVERVIEW OF POSITION:
Responsible for patient and provider outreach initiatives and serving as a project resource for the IPA Operations Department and provider relations managers
Consistently exhibits behavior and communication support skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
Visits provider offices to support clinical quality performance including, but not limited to reviewing patient charts, making patient outreach calls to schedule appropriate screenings/visits and educating provider office staff on best practices.
Makes outreach call reminders to patients for quality measure testing and appointments
Makes patient calls, advising them of changes in their physician network as needed
Supports quality measures, P4P and STAR by outreaching to provider offices with pursuit lists and education
Creates outreach call result grids as directed that summarize data, outcomes, issues, etc.
Creates tracking grids related to assigned projects to ensure that the projects are completed timely and thoroughly and with appropriate documentation.
Makes outreach and follow-up phone calls to physician offices related to specific initiatives or meetings
Responds to and resolves questions or concerns from clinicians or staff in a timely and service-oriented manner.
Supports the Operations team to drive meaningful performance in clinical quality initiatives and outcomes
Produces reports to help track and trend quality of care performance
Acts as a liaison, contact person and/or frontline representative to external HMOs and other agencies; maintains a positive and professional relationship with all internal and external stakeholders (health plans, hospitals, and providers).
Researches Pay-for–Performance (P4P) performance and discrepancies.
Resolves and responds to patient issues in a timely manner by interfacing with HCP internal departments and/or provider offices.
Coordinates mass mailing and outreach projects to providers and patients.
Effectively utilizes Microsoft Word and Excel to mail merge letters and track/trend performance.
Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Performs additional duties as assigned.
Bachelor’s degree preferred.
Over 1 year and up to and including 3 years of experience.
Prior experience in a health plan, medical group, physician office or IPA setting working with physician networks.
Customer service and/or consultative sales experience.
Bilingual (English/Spanish) preferred
Valid CA Driver's license and reliable transportation to local provider offices
KNOWLEDGE, SKILLS, ABILITIES:
Passion or demonstrated interest in healthcare.
An understanding or familiarity with managed care or population health management principles and reimbursement mechanics.
Natural curiosity for understanding how things work and then coming up with ideas for improvement.
Commitment to learning and growing
Being a team player—“If the team wins, I win!”
Excellent verbal and written communication skills.
Ability to effectively interface with all levels of management
Working knowledge of Microsoft Office (Word, Excel, PowerPoint).
Knowledge of CPT II and ICD-10 coding systems is preferred
Strong customer service and interpersonal skills.