Duties & Responsibilities:
Interacts with hospitals, providers, and members to improve quality of care, monitor progress, and recommend changesReviews billing codes, medical records, and claims submission processes to ensure accuracyAttends and facilitates any initiative meetings (studies, partnerships) that involve targeted providers and/or measuresCompletes on-site provider visits to implement work plans and conduct provider education sessions regarding appropriate coding practices and chart documentationCollaborates with other departments to maximize member outreach for preventive services and chronic disease managementAssists in writing member and/or provider articles on HEDIS, QARR, Medicare Advantage, and/or health promotions for the HF newsletterAssists and supports regulatory affairsDocument all relevant interactions in appropriate systemsAdditional duties as necessaryMinimum Qualifications:
Associate’s degree from an accredited institutionAbility to travel around the NYC metro areaPreferred Qualifications:
Bachelor’s Degree from an accredited institutionClinical license: LPN, RN, LMSW or LCSWMultiple years of HEDIS review experience for both Medicaid and Medicare lines of businessMedical record review experience directly working on HEDIS/QARR in a managed care settingGood presentation, relationship management, and analytical skillsIntermediate MS Word, Excel, and PowerPointHiring Range*:
Greater New York City Area (NY, NJ, CT residents): $81,099 - $116,480
All Other Locations (within approved locations): $71,594 - $106,080
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.