Insurance & Value Based Care Specialist - CHC

Insurance & Value Based Care Specialist-Community Health Center

Join our mission to provide a comprehensive continuum of care for people in Louisiana, encompassing primary care, behavioral health, and substance use disorder treatment. Help save lives at OHL!

Job Summary

Odyssey House Louisiana, Inc. is seeking a full-time Insurance Verification & Value-Based Care Specialist for our Community Health Center. In this role, you will verify insurance coverage for all clients and enter information in a timely manner into our EHR. In addition, you will be responsible for ensuring the utilization of billing codes to optimize health centers' Value-Based Care programs.  Applicants should have an associate degree and medical billing experience. Bilingual communication skills are a major plus.  The role is a hands-on position leading their assigned practices in improving Key Performance Indicators (KPIs) outlined in Value Based Payment (VBP) agreements. These KPIs include clinical quality measures, membership engagement, facility utilization, and cost measures.

Responsibilities and Duties

It is the duty and responsibility of the Insurance & Value Based Care Specialist to:

·        Work with the Director to understand, precisely document, and prioritize all value-based contract requirements, and then organize these requirements into a coherent roadmap that outlines key activities and milestones;

·        Use available data and best practices to develop creative and innovative strategies, interventions, and other performance improvement strategies in collaboration with health center members;

·        Track payer payments and escalate issues as necessary to the Director;

·        Prepare and present progress against goals monthly to Director;

·        Responsible for providing project coordination, analytical reporting, and operational support for increasing access to health services with/for an identified population through the health centers’ care management team;

·        Increase access to health services with/for an identified population through the health centers’ Clinic Leadership team as directed by Director;

·         Develop, maintain, share, and educate stakeholders on complex analytical models supporting data literacy;

·        Lead practice transformation and practice performance improvement initiatives;

·        Guide Health Centers in achieving targeted goals and outcomes, to improve quality, efficiency, and utilization;

·        Use data to identify and deliver actionable insights to key stakeholders, including trends in prescribing and new opportunities for improvement;

·        Work with Clinic Leadership team to improve chronic disease management and promote preventive care, as appropriate, to reduce the utilization of inappropriate care settings (e.g., avoidable emergency department visits);

·        Develop transformation plan, including strategies for improvement in utilization metrics and HEDIS and other Quality Measures, based on performance analysis data and established targets;

·        Facilitate effective practice improvement meetings with Director, to monitor, present, and discuss progress on the transformation plan;

·        Analyze cost, utilization, and quality data from multiple data sources, including, but not limited to, payer portals and payer claims;

·        Use data dashboards to educate and foster opportunities for change in clinical workflow;

·        Review monthly practice team reports and facilitate improvement strategies;

·        Verify insurance information for all appointments;

·         Update insurance information in EHR for all appointments;

·        Update utilization of billing codes in EHR to ensure health center optimizes Value-Based Care programs ;

·        Other duties, as assigned.

Qualifications and Skills

Required:

·        Bachelor’s degree required;

·        Degree in health care administration, nursing, business management, public health, or another health-related field preferred. A person not possessing a bachelor's degree may be considered if their combination of education and experience matches what is needed for this role;

·         Must be flexible, self-motivated and a team-player;

·        Ability to work at a fast pace, take initiative, problem-solve, and develop high-quality content;

·        Ability to manage multiple priorities;

·        Excellent administrative skills required to manage work on a variety of programs with varying deadlines and program responsibilities;

·        Experience working in an accountable care organization preferred;

·        Experience working with health care analytics and performance reporting;

·        Experience with healthcare transformation, process improvement, workflow redesign, and continuous quality improvement methodologies preferred;

·         Demonstrates the highest level of professionalism, integrity, and ethical values;

·         Presents themselves in a positive disposition, is highly effective in communicating with internal and external individuals to foster successful team collaboration and encourage a positive organizational culture

·         Knowledge of CPT codes and basic medical terminology (preferred)

·        Value-Based Care experience

·        Phone communication skills

·        Bilingual ability (English/Spanish) a plus

Preferred:

Preferred qualifications include the following:

·        Masters in public health

·        1-2 years with Value Based Care programming

·        PMP

Compensation and Benefits

Competitive compensation and benefits package includes insurance (health, dental, vision, life, long-term and short-term disability), leave benefits and 401k match.