Insurance Incentive Programs

• Medical Record review and data mining of pertinent quality measures for documentation and subsequent reimbursement to EHN
• Coordinating appointments with selected patients to:
• Establish care with a valued member of the EHN provider team
• Annual Medical Condition Review and/or Annual Wellness Exam visits with a provider
• Increasing Volumes on Annual Wellness Visits and Physicals.
• Understand, develop relationships, and optimally works with many different insurance organizations.
• Medication Adherence with all insurance companies.
• Works with insurance companies to obtain list of non-adherent patients.
• Establish partnership with pharmacies to accomplish Med-Adherence with all patients.
• Quality and Hedis Measures
• Educates providers, Medical Assistant, and staff off all measures
• Works with insurances companies on maintaining star ratings
• Shadows and Educates Medical Assistants on completing Quality Measures

Coding and Billing

• Develops spreadsheet of insurance carrier guidelines for proper coding and billing procedures for evaluation and management, preventive physical, and annual wellness visits
• Educates providers regarding the above and serves as a resource to the Provider Team
• Works with providers to develop and/or modify medical record templates for documentation to be obtained for the appropriate organizations
• Educates Billing on any new coding guidelines and documentation

Quality Improvement

• Assists the EHN QI Team Leader in the attendance and communication to EHN Providers the Quality Initiatives noted above at monthly provider meetings
• Other projects as mutually agreed upon with the QI Team Leader 
• Implementation and education of all incentive programs

Professional:

• Self-Motivated, Compassionate, Integrity, Friendly, Faithful, and Fun! (SCIFF Attributes)
• Provides suggestions to operational and clinical leaders for the purpose of improving care process models, evaluating opportunities for appropriate cost-containment, and improving patient satisfaction.
• Communication Skills: Effectively gives and receives information in individual and group situations.
• Excellent interpersonal skills, ability to perform critical analyses and affect change
• Customer Service: Makes the effort to listen to and understand the customer (both external and internal); anticipates customer needs; gives priority to customer satisfaction.
• Initiative: Actively attempts to influence events to achieve goals; self-starter. Taking action to achieve goals beyond what is necessarily called for; originating action.

• Two years in a clinic setting preferred
• MA/CNA experience preferred 
• Population Health experience preferred 
• Excellent interpersonal communications skills
• Outstanding organizational skills
• Scheduling, referral, and coordination of benefits and services 
• Data mining