- Follows established Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and sensitivity to confidential information.
- Responsible for monitoring information and data delivered by BCBSM PGIP; processes the data into reports in accordance with internal procedures.
- Collaborates with internal staff to define data analysis projects, identify appropriate data sources, and develop meaningful and actionable output. Works closely with the Clinical Quality Coordinator - PGIP and supplies reports as requested for quality data analysis and interpretation.
- Prepares charts, graphs, and tables as requested, including periodic and ad-hoc reports for the department; plans/develops simple databases and queries to support PGIP program activities and requirements.
- Develops and maintains data preparation and validation routines; reviews output to ensure the accuracy and validity of presented information/program data.
- Responsible for uploading and maintaining up-to-date reports for end users (partner practices) within the data sharing application.
- Responsible for the required quarterly user access reconciliations for the data sharing application.
- Maintains proficiency of the data sharing application utilized with partner practices; provides ongoing support, and training of the application with end-users (partner practices staff).
- Responsible for submitting and entering accurate provider and practice information within appropriate BCBSM PGIP systems.
- Provides support and assistance to clinical users regarding data reports and queries and assists with troubleshooting and issue resolution.
- Assists Clinical Services Manager - PGIP with processing payment, creating finance structures, payment reports and scorecards.
- Assures resolution of identified problems in clinical data in conjunction with the medical director, director of population health, clinical program managers, clinical coordinators, and the Information Systems (IS) department.
- Provides and maintains up-to-date written documentation of all activities; logs all work performed as appropriate.
- Participates in departmental and interdepartmental process improvement; recommends improvements in processes as opportunities are identified.
- Demonstrates general knowledge of National Committee for Quality Assurance (NCQA) standards and Healthcare Effectiveness Data Information Set (HEDIS) measures as they relate to clinical reporting.
- Attends and participates in organizational, departmental, and clinical team meetings, as well as with external entities when required.
- Maintains confidentiality of client data.
- Performs other related duties as assigned or requested.
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health data coordinator - Harvey, MI , USA, United States - Upper Peninsula Health Plan
3 weeks ago
Description
POSTED:
April 26, 2024
POSITION:
Health Data Coordinator -PGIP
DEPARTMENT:
Clinical Services
POSITION SUMMARY:
Assists a subset of the Clinical Services Department with information and data management for the Blue Cross Blue Shield of Michigan (BCBSM) Physician Group Incentive Program (PGIP).
ESSENTIAL DUTIES AND RESPONSIBILITIES:
POSITION QUALIFICATIONS:
Education:
Minimum:
Associate degree in health information technology, health information management, computer
information systems, or related field
Preferred:
Bachelor's degree in health information technology, health information management, computer
information systems, or related field
Experience:
Minimum:
One (1) year of experience in an information systems or technology-related environment
Preferred:
Three (3) to five (5) years working in a healthcare setting with progressive experience in data reporting and project management
Required Skills:
Keyboarding proficiency and advanced knowledge of Microsoft Office (Word, Excel, Access, and PowerPoint) including proficiency in database management
Excellent human relation and oral/written communication
Excellent project management and organizational abilities
Ability to work independently
Ability to adhere to deadlines and manage multiple tasks effectively
Ability to be flexible and adaptable to changing priorities
Desirable Skills:
Knowledge of terminology and concepts used in the healthcare and health insurance industry
Knowledge of accounting and health-care software systems/applications
Knowledge of claims and coding and billing methodologies
Knowledge of clinical HEDIS, NCQA, and Centers for Medicare and Medicaid Services (CMS) regulations
The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description.
The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.
Physical Requirements:
[This job requires the ability to perform the essential functions contained in the description. These include, but are not limited to, the following requirements.
Reasonable accommodations may be made for otherwise qualified applicants unable to fulfill one or more of these requirements]:
Ability to access departmental files
Ability to enter and access information from a computer
Ability to access all areas of the UPHP offices
Moderate physical effort (lift/carry up to 25 pounds)
Occasionally lifts supplies/equipment
Occasional reaching, stooping, bending, kneeling, crouching
Prolonged periods of sitting
Occasional prolonged standing
Manual dexterity and mobility
Working Conditions:
Works in office conditions, but occasional travel may be required
Subject to many interruptions
Exposure to situations requiring exceptional interpersonal skills or high productivity
Occasionally subjected to irregular hours
