Certified Coder highly preferred.
Responsible for placing outreach calls to members with chronic medical conditions to encourage participation in chronic condition management programs. Primary duties may include, but are not limited to: Provides information about the House Call Program to members with chronic conditions and explains the benefit of having chronic conditions managed, assessed and treated. Responds to member or provider written or inbound telephonic communications or inquiries with respect to chronic condition outreach or STARS clinical interventions.
Requires a BA/BS in a related field; 3 years of related experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted RN license in applicable state(s) required. Understanding of complex business processes, including CMS Risk Adjustment payment model and a clinical understanding of the management of chronic conditions including diagnosis coding (ICD-9/HCCs), CMS STARS ratings, HEDIS and Medicare Advantage products strongly preferred.