Highmark Health Pay for Value Practice Specialist- Hybrid- Full Time in Boston, Massachusetts
Allegheny Health Network
Job Description :
Responsible for working collaboratively with primary care providers and care teams to provide education, workflow design and hands on assistance to meet the P4V program goals all payer programs. Partners with Physician Quality Chairs to coordinate Quality Committee meetings and strategic programming elements.
Directly responsible for providing office based workflow transformation including hands on workflow strategies and training/education to the PCP practices that will optimize efficiencies and productivity in the area of value based reimbursement programs. (15%)
Directly responsible for assessing data for opportunities in PCP performance and implementing strategic plans to meet program targets across the practices' P4V programs such as ACA, Medicare STARS, HEDIS and risk revenue for all payers. (25%)
Collaborates with EHR teams in the development and implementation of standardized documentation templates, registries and GAP reports within the EHR. (5%)
Directly responsible for analysis, interpretation and implementation of action plans for PCP value based reimbursement programs in the areas of NCQA, HEDIS, GPRO, PQRS and Meaningful Use. Develops strategic plans to meet PCP program targets and effectively communicates this information at monthly practice meetings. (30%)
Proactively engages the practice care team and provides "hands on" management of clinical quality measures and quality chart review. (5%)
Participate in the development and presentation of instructional materials for PCP practices to proactively close care GAPS at the point of service. (10%)
Responsible for tracking, analysis and trending of outcomes for all value based programs for assigned practices and provide progress reports to appropriate parties. (5%)
Works collaboratively with Quality Chairs to develop meeting agendas, Quality Committee reports and co-chairs committee meetings. (5%)
Bachelor's degree or equivalent combination of education and experience
Valid driver's license
2 years’ experience with Medicare STARS, Medicaid HEDIS, GPRO, risk value streams or population health management
- RN license
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
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Req ID: J221991
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