Government Programs Quality Specialist

1 week ago

Des Moines, Iowa, United States Wellmark, Inc. Full time
Job Description

Wellmark, Inc. is seeking a highly skilled and detail-oriented individual to join our Government Programs team as a Quality and Risk Adjustment Coordinator. In this role, you will play a critical part in supporting the day-to-day quality and risk business operations, collaborating with various stakeholders to ensure the delivery of high-quality services to our members.

About the Role

As a Quality and Risk Adjustment Coordinator, you will be responsible for providing support with provider engagement requests related to the Medicare Advantage stars and risk adjustment programs, as well as Qualified Health Plan (QHP) risk adjustment activities. You will work closely with the Wellmark Technology team to manage the technology tools and updates required by Blue Cross Blue Shield Association (BCBSA). Additionally, you will partner with the Network Performance team, vendors, and other internal Wellmark stakeholders to identify best practices and workflows to streamline efficiencies in processes related to provider engagement and medical records requests.

About You

We are looking for a highly organized and efficient individual who is not afraid to learn and take on new challenges. You should be a strong communicator, both verbally and in writing, and enjoy working in a team environment where you can collaborate and bounce ideas off others. You should be a self-starter, resourceful, and tech-savvy, with a willingness to learn new systems and software. If you are passionate about working in a dynamic environment where no two days are the same, and you are eager to grow your skills and knowledge in the government programs side of health insurance, we encourage you to apply for this opportunity.

Qualifications
  • Bachelor's degree in health, business, or related field, or direct and applicable work experience.
  • 1+ years of related work experience in a healthcare-related environment with preferred experience in one of the following areas: contracting, claims payment, customer/provider services, quality improvement, or risk adjustment.
  • Demonstrated proficiency in using Microsoft products such as Word, Excel, Outlook, or PowerPoint.
  • Demonstrated verbal and written communication skills with the ability to clearly and concisely articulate information to stakeholders.
  • Proactive, resourceful self-starter with effective prioritization skills and strong attention to detail. Adaptable and flexible with changing priorities.
  • Analytical, problem-solving, and workflow management skills.
  • Ability to work both independently and collaboratively with project teams.
  • Naturally curious, inquisitive, and willing to ask questions to achieve goals focused on the desired outcomes.

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