Payer Operations & Support Specialist, Ambulatory Clinical Documentation Improvement (CDI)

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

Job Type:

Regular

Scheduled Hours:

32

Work Shift:

Day (United States of America)

Reporting to the Director, Process Improvement & Design, the Payer Operations & Support Specialist, Ambulatory Clinical Documentation Improvement serves as a key member of the team. BILHPN provides population based initiatives aimed at providing high quality care that is cost effective. The Payer Operations & Support Specialist of Ambulatory Clinical Documentation Improvement (CDI) directs and manages payer deliverables within our value based contracts related to CDI. Serving payer value based contract needs includes consultation, program integration, deliverable oversight, evaluations, and refinements.

Job Description:

Essential Duties & Responsibilities including but not limited to: 
Provides internal consultative direction related to payer needs on programs, initiatives, resourcing, and strategy within the Ambulatory CDI division.
Develop and optimize integration of applicable payer needs and considerations within CDI programs
Perform evaluations and gap analyses regarding payer requirements to appropriately develop interventions that are needed to support CDI value based contract requirements 
Collaborate on provider trainings efforts that support findings from payer analyses, including individual provider trainings and resources/content needed as applicable
Create action plans, roadmaps, and business cases for opportunity within the payer space that needs to be addressed to perform appropriately
Maintains inventory of payer deliverables within the Ambulatory CDI division
Manages payer deliverables through the full lifecycle – planning, execution, monitoring, and completion
Attends payer specific meetings related to Ambulatory CDI, including gathering of and updating materials
Synthesizes and reviews payer analyses performed on a monthly basis to drive appropriate capture. Presents mid- course corrections when adequate progress towards goals is not being achieved
Refines current CDI processes related to payer requirements
Compiles any materials related to CDI payer requirements
Leads communication efforts with payer stakeholders
Develop and maintain strong vendor relationships that support project(s) success as related to CDI payer deliverables
Proactively support addressing impacts, barriers, and risks to deliverables
Communicates content information appropriately to stakeholders, local leaders, administrators, support staff, BILHPN teams, and providers
Build and maintain working relationships with internal teams, practice operations, and provider community to foster collaboration and partnership in driving meaningful change within Clinical Documentation Improvement

Organizational Requirements: 
Maintain strict adherence to the Lahey Health Confidentiality policy.
Incorporate Lahey Health Standards of Behavior and Guiding Principles into daily activities.
Comply with all Lahey Health Policies.
Comply with behavioral expectations of the department and Lahey Health.
Maintain courteous and effective interactions with colleagues and patients.
Demonstrate an understanding of the job description, performance expectations, and competency assessment.
Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
Participate in departmental and/or interdepartmental quality improvement activities.  
Participate in and successfully completes Mandatory Education. 
Perform all other duties as needed or directed to meet the needs of the department.

Minimum Qualifications: 
Education:    A Bachelor’s Degree in Healthcare Management, Administration, Public Health, Business Administration, or other related functional area is required. Master’s degree in related field preferred. 

Licensure, Certification & Registration:    N/A

Experience:    
2-5 years of experience with Clinical Documentation Improvement (CDI), coding, risk adjustment, or other related field within a healthcare environment and 1-4 years of experience working for or with payers within healthcare required. Experience with strategy and opportunity evaluation a plus.
•    Ability to make decisions that are guided by precedents, policies and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.
•    Ability to set goals and priorities for functional area. May make recommendations for department policies, practices and programs. Director provides broad guidance and overall direction.
•    Ability to communicate complex information in English effectively in writing to all levels of staff, management and external customers across functional areas.
•    MS Office applications with advanced skills in Word, PowerPoint, Excel and Outlook required; Experience with databases preferred
•    Ability to verbally communicate complex concepts in English and address sensitive situations, resolve conflicts, negotiate, motivate and persuade others.
•    Ability to demonstrate knowledge of CDI/ acuity/ risk management concepts, practices and policies.
•    Ability to act as a team leader for payer deliverable initiatives, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.
•    Ability to provide a high level of customer service
•    Strong organizational skills and the ability to articulate complex workflows and processes
•    Experience with fast paced, high-visibility initiatives 
•    Ability to work with varying teams and communicate needs

Skills, Knowledge & Abilities:      Microsoft Word, Excel, Powerpoint, Project or SmartSheet (preferred), EMR application knowledge, population health management software (preferred) 

Key Relationships: 
1    BILHPN Ops Teams    
2    BILHPN Clinical Excellence Teams    
3    Risk Unit Leaders    .
4    Vendor Contacts (as applicable)    
5    Practice/Risk Unit Staff    
6    Providers    
7    BILHPC Pop Health Leaders    
 
Scope/Impact Statement: 

Work Schedule: Indicate either Yes or No as appropriate.  Hours of work may be subject to change based upon the needs of the business/department.

On Call:  No    Shift Rotation: No    Weekends: No

Physical Requirements & Environment: Required

Mental and Visual Attention Required
X    The position requires periods of concentrated mental and visual attention.
Physical Exertion
    Weight
X    Nature of work requires lifting or moving light weight (up to 20 pounds).
    Dexterity
X    Flow of work and character of duties require average manual coordination.
Range of  Motion
 X    Duties require average range of motion.
   Physical Conditions
 X    Performance of duties requires remaining in position for prolonged periods of time.
    Repetitive Motion
 X    Assignments require frequent repetitive motion.
Working Conditions
X    Working conditions include minimal exposure to elements such as odor, noise, dust, chemicals, temperature extremes or airborne pathogens.
Exposure to Hazardous Materials
X     Performance of duties generally does not involve exposure to hazardous materials.
 

FLSA Status:

Exempt

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement.

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