Risk Adjustment Coordinator

Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members.

SHP operates a portfolio of health plan products under several different legal structures : InterCommunityHealth Plans, Inc.

IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc.

offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan.

As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.

This is a remote position in which we are able to employ in the following states : Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin

• JOB SUMMARY / PURPOSE
• Develops and maintains initiatives and programs to enhance risk adjustment outcomes for Medicare members, and ensures member medical records are in compliance with CMS's Risk Adjustment Validation procedures.

Responsible for communicating with physician offices through various means for completeness of member medical records and facilitating and / or providing educational training where applicable.

Works closely with the Risk Adjustment Analyst and Revenue and Risk Manager to ensure the success of programs.

• DEPARTMENT DESCRIPTION
• Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures : InterCommunity Health Plans, Inc.

IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc.

offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan.

As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.

• EXPERIENCE / EDUCATION / QUALIFICATIONS
• Bachelor's Degree or equivalent experience required.
• One (1) year related experience in a healthcare setting required.
• Experience with computer applications, including MS Office (Excel, Word, PowerPoint) required.
• Medicare Advantage risk adjustment experience preferred.
• KNOWLEDGE / SKILLS / ABILITIES
• Effective written and verbal communication skills to perform group presentations, tactfully discuss issues, and listen to and understand concepts, rules and procedures.

Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.

• Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.
• Excellent organizational skills with the ability to manage multiple tasks and prioritize effectively.
• Ability to work collaboratively in a team environment.
• PHYSICAL DEMANDS

Rarely

1 - 10% of the time)

Occasionally

11 - 33% of the time)

Frequently

34 - 66% of the time)

Continually

67 100% of the time)

CLIMB - STAIRS

LIFT (Floor to Waist : 0"-36") 0 - 20 Lbs

LIFT (Knee to chest : 24"-54") 0 20 Lbs

LIFT (Waist to Eye : up to 54") 0 - 20 Lbs

CARRY 1-handed, 0 - 20 pounds

BEND FORWARD at waist

KNEEL (on knees)

STAND

WALK LEVEL SURFACE

ROTATE TRUNK Standing

REACH - Upward

PUSH (0 - 20 pounds force)

PULL (0 - 20 pounds force)

CARRY 2-handed, 0 - 20 pounds

ROTATE TRUNK Sitting

REACH - Forward

MANUAL DEXTERITY Hands / wrists

FINGER DEXTERITY

PINCH Fingers

GRASP Hand / Fist

PI250457673