High School/GED from Nationally Accredited College/Universit
1 Year Experience Required
Allegan General Hospital seeks a full time Professional Incentives Specialist to work for our Quality & Risk Management department.
*Please be advised that only current Allegan Healthcare Group employees will be considered for this position at this time.
JOB DUTIES include, but may not be limited to:
-Pulls LAG reports from Meridian, BCBS, BCN, Priority Health and Humana, or other payers as designated via websites for patients scheduled for appointments in the near future (i.e., current week, next week). Distributes the reports for patients with upcoming appointments to the appropriate clinic.
-Enters all information into computer systems accurately and timely.
-Prints reports from the insurance companies to see where we need to focus on closing the gap for incentive payments.
-Receives reports from payers such as Tessellate (Blue Cross of Michigan), sends sheets showing deficiencies to the appropriate provider to indicate whether the deficiency was addressed and documented during the visit.
-Ensures that all LAG reports received are entered in a timely manner in the various insurance databases.
-Provides monthly reporting to leadership of incentive measure in order to identify progress towards annual incentive goals.
-Meets with various insurance incentive representatives to identify where we can improve our care and documentation to maximize incentive payments.
-Works closely with Quality Assurance Nurse on any clinical issues or questions that may arise from reviewing charts (e.g., high BP not checked a second time, medical charting questions, etc.)
-Monitors patients to ensure appointments are kept and contacting patients who are indicated as due. Answers patient questions regarding appointments and testing or scheduling follow up appointments.
-Travel associated with conferences, meetings, and program updates.
QUALIFICATIONS include, but may not be limited to:
-Current Medical Assistant certification (or Licensed Practical Nurse) minimally required.
-1-2 years minimum work experience as medical assistant (or LPN) in a large physician office setting required.
-Minimum one (1) year experience in healthcare incentive work or equivalent preferred.
-Computer literate with ability to effectively utilize software programs and computer applications required for the job. Proficient with Microsoft word and excel.
-Ability to type accurately and effectively.
-Ability to accurately spell; copy numbers and letters from one document to another.
-Excellent customer service skills in working with a variety of individuals including providers, administration, and fellow employees.
-Ability to multitask and re-prioritize amidst frequent interruptions.
-Ability to use multiline phones, copiers, and/or any other office equipment necessary to complete job duties.
Allegan General Hospital is an Equal Opportunity Employer.