Insurance Verification Jobs in Augusta, GA (NOW HIRING)

Assistant Director of Population Health

Center for Primary Care

Who we are:

For over 30 years the Center for Primary Care (CPC) has cared for families in the CSRA by providing patients with the most convenient, accessible, and personal healthcare available. Our mission is to improve the health and wellbeing of the families we serve by providing compassionate and high-quality care in a joyful setting. Thephysicians, healthcare professionals, and support team at our 9 practices, plus laboratory, imaging, and corporate locations work to transform our mission into action.

AtCenterfor Primary Care,weunderstandthatthework environmentisasimportantasthe hardwork youdo. Center for Primary Care is Great Place to Work Certifiedwhich means our employees share feedback on their workcultureexperiencesandwelistenandstrivetocreatepositiveemployeeexperiencescenteredonjoy,trust, andbelonging.

Learn moreaboutCPC’scultureand Great Place to WorkCertificationby clickingon thelinkbelow:

Coverage that cares for body, mind, and spirit.

Comprehensive benefits including no charge medical, lab, and imaging visits at Center for Primary Care locations.

Mental Health Support Services and Resources.

Retirement plan with generous, 100% vested employer match plus profit sharing.

Paid Time Off including 6 weeks 100% Paid Parental Leave.

Employee Discount Programs

The Assistant Director of Population Health and Operations is responsible for supervising CPC’s management of quality improvement initiatives, quality care coordination team, and value-based care programs.

Quality and valued-based programs that CPC currently participates in are ACO plans, multiple Medicare Advantage programs, CMS's MIPS/MACRA program (Including MSSP), and Commercial Payor Programs (including EPHC, BCBS SC, and others as needed). Primary focus for this position will be on MSSP & Commercial programs. The Assistant Director will assist in the overall development, implementation, and maintenance of the organization's quality department and these programs.

The Assistant Director will use relevant clinical applications software to capture, analyze and evaluate data to prove adherence, support workflows and measure improvement. The Assistant Director will serve as a support person for corporate-wide quality initiatives.

Essential Functions

• Works with the Quality Manager to oversee a clinical quality team to help carry out department and corporate goals. Staff will report directly to the Quality Manager, with reporting responsibility to the Assistant Director.
• Oversees and leads improvement projects related to strategic quality improvement and reporting initiatives.
• Supports clinical teams in planning improvement activities utilizing standardized improvement methodologies and data.
• Understands policies, standards, measures, and benchmarks that the organization needs to adhere to and works with Director of Operations and IT Department to integrate software applications, resolve conflicts, evaluate and improve capturing of clinical information, and ensure smooth operation of integrated applications.
• Regularly analyzes reports on clinical quality indicators for performance improvement activities.
• Lead and attend provider and staff-level meetings to present program details, updates, and directives.

All essential functions must be performed. Reasonable accommodations may be made to enable individuals with qualified disabilities to perform the essential functions . The above information is intended to describe the general nature and level of work being performed by people assigned to this job. It is not intended to be an exhaustive list of responsibilities, duties and skills required of personnel so classified. Examples listed do not preclude the performance of other duties similar in nature or in level of complexity.

Requirements

Qualifications for Success:

Education, License/Certification, and Experience Requirements

Education: Associate or bachelor’s degree in health care or related field.

Experience: At least two (2) years of experience in a supervising role required. Experience with Athena One strongly preferred.

• Knowledge of Electronic Health Records (EHRs)
• Proficient in Microsoft Office, including Excel, Word, and Access
• Knowledge of insurance carriers, Medicare and commercial
• Knowledge of quality incentive programs, including HEDIS measures, and shared savings programs
• Knowledge of Insurance Verification, Pre-Authorizations and Pre-Certifications
• Ability to analyze, collect, and report data to insurance payers
• Ability to identify emergent medical situations
• Demonstrate positive customer service skills
• Ability to function in a fast-paced work environment, multi-tasking

Additional Job Details:

Work Setting: On-site

Job Type: Full-Time

Schedule: Monday-Friday

Mental/Physical Requirements: Stooping, turning, bending, squatting, kneeling and the ability to lift up to 50 pounds; constant/repetitive standing; requires normal, correctable vision and hearing.

Compensation: Market competitive base pay, commensurate with education and experience.

Summary

Center for Primary Care isan equal opportunity employer and complieswith federal,state,and local anti-discrimination laws, regulations, and ordinances.