**Description**

Population Health Specialist

Brown & Toland Physicians - Oakland

SUMMARY :

The Population Health Specialist supports day to day operations of the Population Health Programs and functions. The role guides programs aimed to increase physician and front office awareness of risk adjustment and quality measures. Implements tools to improve and measure medical group and physician performance. Ensures proper benchmarks for various programs are monitored to ensure program effectiveness. Working closely with the department manager and staff, coordinates the organization strategies and initiatives related to both Risk Adjustment Programs and clinical quality measure specifications following federal and state standards including CMS and NCQA standards and continuous quality improvement principles. Perform other duties as assigned.

ESSENTIAL JOB FUNCTIONS:

1. Collect and review medical records and supporting documentation, determine completeness and accuracy of medical records and supporting documentation as it relates to HEDIS, VBP4P and CMS STARs specifications.

2. Runs and monitors monthly reports from database to identify and/or correct any incorrect data.

3. Identify, recommend and implement a standardized approach to perform and score quality audits and performance monitoring.

4. Send out monthly updates to Vendor and management team, including report findings and recommendations regarding closing healthcare gaps, medical record documentation, and additional educational training to management.

5. Participate in ongoing discussions concerning data collections and analysis for HCC, HEDIS, VBP4P and CMS STARs internally and externally

6. Maintain current knowledge of the HEDIS, VBP4P, CMS STARs measure specifications and communicate changes to internal teams.

7. Creates, updates, and enhances materials to assist physicians and staff on Risk Adjustment Programs and HEDIS, VBP4P and CMS STARs. Collaborates with analysts and other department members to customizes education and education materials for various audiences including support staff, primary care physicians, specialists, billers, coders, and employees of other healthcare delivery systems.

8. Establish and maintain effective and cooperative working relationship with internal staff, physician practices and other external contacts

9. Understand the principles of Risk adjustment, CMS, HEDIS, NCQA, Health Plan Quality Standards related to HEDIS, P4P, STARs measures.

10. Perform monthly provider validation via web portal.

11. Help onboard external members from the AHA program, including coordination with compliance, credentialing, PPS and I.T.

12. Maintain master trackers for both NP AHA, and Quality outreach programs by attending weekly Ops meetings.

13. Monthly invoice reconciliation for provider network around NP AHA program.

QUALIFICATIONS & REQUIREMENTS:

1. Job related Knowledge, Skills, and Abilities, including Documentation, if pertinent.

Must have intermediate knowledge of Microsoft Office suite. Proficiency with population health management applications and tools Must demonstrate the ability to follow through and meet deadlines. Must display strong problem-solving skills and have excellent oral and written communication skills. Must be able to prioritize tasks and work independently with minimal supervision. Attent ion to detail and overall administrative skills are essential to this position.

2. Creative, Problem-solving, and Innovation Skills.

Ability to think creatively and work collaboratively to address problems. Ability to present solutions to multidisciplinary teams.

3. Customer Focused and Communication Skills.

Ability to write and present reports and presentations. Excellent written and verbal communication skills, including ability to communicate complex issues to different audiences.

EDUCATION AND/OR TRAINING:

Required Education: Bachelor's degree or equivalent training and work experience.

EXPERIENCE:

One to three years of applicable experience in Health Care setting to include coordinating Risk Adjustment Programs and HEDIS medical record review; experience with working across multiple departments with a variety of employees to achieve program goals.

Experience in Managed Care is a plus.

Clinical training (Medical Assistant)

OTHER CRITERIA:

Motivated individual desired who takes initiative and approaches work with enthusiasm in a team environment. Complies with policies and procedures; performs job professionally with respect to others, to property, and to individual safety; works effectively with others to encourage teamwork and productivity. Maintains strict confidence of client information, ensuring client's privacy, and does not discuss internal business with external entities.