Pay for Value Practice Specialist - Hybrid position - Pittsburgh

Company :

Job Description : 

GENERAL OVERVIEW:

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.

ESSENTIAL RESPONSIBILITIES:

• 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%)

QUALIFICATIONS:
Minimum

• Bachelor's degree or relevant experience and/or education as determined by the company in lieu of bachelor's degree
• 2 years’ experience with Medicare STARS, Medicaid HEDIS, GPRO, risk value streams or population health management

Preferred

• 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.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

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