Value Based Care Program Coordinator

Current Employees:

If you are a current employee, please apply via the internal career site by logging into your Workday Account and clicking the "Career" icon on your homepage.

Primary Location

Rapid City, SD USA

Department

CS Value Based Incentive Program

Scheduled Weekly Hours

40

Starting Pay Rate Range

$54,371.20 - $67,953.60

(Determined by the knowledge, skills, and experience of the applicant.)

Job Summary

The Value Based Care Program Coordinator role is responsible for data management for system value based care programs, supporting, developing and maintaining service relationships with all external vendors for data management for traditional Medicare (MSSP or successor), Medicare Advantage and Medicare cost programs, State vendors for Managed Medicaid and any commercial value based care programs, including but not limited to management of the fee for service plan administrator, plan brokers, plan stoploss vendor, plan pharmacy administrator and for the Employee Health Plan.

Monument Health offers competitive wages and benefits on qualifying positions. Some of those benefits can include:

*Supportive work culture

*Medical, Vision and Dental Coverage

*Retirement Plans, Health Savings Account, and Flexible Spending Account

*Instant pay is available for qualifying positions

*Paid Time Off Accrual Bank

*Opportunities for growth and advancement

*Tuition assistance/reimbursement

*Excellent pay differentials on qualifying positions

*Flexible scheduling

Job Description

Essential Functions:

• Data management for all value based programs, pulling requested data from vendor and internal data warehouses, submitting quality, care gap and other data to vendors as requested.
• Monitors and manages Third Party Administrator claims processing for the Employee Health Plan and all value based programs and resolves claims payment, denials or other items as identified..
• Monitors, Employee Plan Stoploss claim management, reporting and transparency to leadership.
• Coordinates internal and external required communications for the Employee Health Plan and all value based programs.
• works directly with Director of Value Based Programs and population health staff on how and when to use Employee Plan benefits to support care plans.
• Supporting Summary Plan Document changes related to network processing variations, benefit changes, exclusions and intent of self-insured coverage to Employee Plan Third Party Administrator, Pharmacy Benefit Manager (PBM) and Stoploss vendor.
• Builds and negotiates single case agreement(s), as required, in accordance with Third Party Administrator processing requirements.
• Manages and monitors claims funding reports and submissions, administrative services funding and payments, and required state and federal reporting for the employee plan.
• Vendor/supplier support for accurate data reporting related to quality, care gaps and other care initiatives and  supports development and use of internal Monument Health Programs.
• Noticing payers, vendors, supplier and data aggregators regarding identified compliance issues,  claims, care gap and quality adjustments and/or plan specific document updates.
• All additional duties as assigned.

Additional Requirements

Required:

Education - High School Diploma/GED Equivalent

Physical Requirements:
Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

Job Category

Finance

Job Family

Financial Services

Shift

Employee Type

Regular

15 Corporate Services Division

Make a difference.  Every day.

Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.