Value Based Care Program Coordinator
2 days ago
The Value Based Care Program Coordinator role is responsible for managing data for system value based care programs, developing and maintaining service relationships with external vendors, and supporting the development and use of internal Monument Health programs.
Key Responsibilities- Manage data for all value based programs, pulling requested data from vendors and internal data warehouses, and submitting quality, care gap, and other data to vendors as requested.
- Monitor and manage Third Party Administrator claims processing for the Employee Health Plan and all value based programs, and resolve claims payment, denials, or other items as identified.
- Coordinate internal and external required communications for the Employee Health Plan and all value based programs.
- Work directly with the Director of Value Based Programs and population health staff on how and when to use Employee Plan benefits to support care plans.
- Support 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.
- Build and negotiate single case agreement(s), as required, in accordance with Third Party Administrator processing requirements.
- Manage and monitor 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.
- Noticing payers, vendors, suppliers, and data aggregators regarding identified compliance issues, claims, care gap, and quality adjustments and/or plan specific document updates.
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.
About Monument HealthMonument 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.
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