![]() Good business acumen, especially as it relates to Medicare Strong problem-solving skills the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action Strong relationship building skills with clinical and non-clinical personnelĭemonstrated ability to interact with medical staff, peers, and internal company staff at all levelsĪbility to solve process problems crossing multiple functional areas and business units Strong communication and presentation skills Microsoft Office specialist with exceptional attention to detail Strong financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models) Knowledge base of clinical standards of care, preventative health, and Star measuresĮxperience in managed care working with network and provider relations ![]() Strong knowledge of the Medicare market, products and competitors Professional experience persuading changes in behavior Registered Nurse with Undergraduate degree or equivalent experienceģ+ years associated business experience with health care industry Identify and assess decision makers and other key provider group personnel with a focus on identifying barriers to achieving targeted outcomesįocus communications and efforts accordinglyĭevelop solution-based, user friendly initiatives to support practice success ![]() Lead Weekly, Monthly, Bi-monthly, Quarterly and / or Annual business Review meetings related to STAR activities which summarize provider group performance and market performance as requested by or required by Quality or Regional leadershipĪnalyze and evaluate provider group structure and characteristics, provider group / provider office operations and personnel to identify the most effective approaches and strategies Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groupsīe the primary go to person for all STARS related activities within their assigned market(s) working within a matrix relationship which includes Quality corporate operations and Regional/Market operationsĪssist in developing of training and analytical materials for Stars and HEDIS RN with minimum of 7 to 10 years of combined experience in the followingĭevelop market business plans to motivate providers to engage in improving Stars measures to be 4 STARS or higher Working knowledge of Medicaid RUG and other case mix reimbursementĮxperience conducting and coding Minimum Data Set (MDS) assessmentsĬomputer proficiency in Word, Excel and PowerPointĮxcellent writing skills including publications and report writing ![]() Working knowledge of Medicare Skilled Nursing Facility Prospective Payment System Write industry specific articles and perform presentations at state and national conferences Provide Medicare and Medicaid management training services to nursing facility providersĬollaborate with BKD nursing facility billers, CPAs and other consultants to meet client needs efficiently and effectivelyĬonsult with LTC providers to address reimbursement opportunities Conduct Medicare and Medicaid management reviews in long-term care (LTC) facilities and/or hospital based skilled nursing units (SNUs) ![]()
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