- Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several different legal structures: InterCommunityHealth Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan.
As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.
This is a remote position in which we are able to employ in the following states: Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin
Occasionally
- JOB SUMMARY/PURPOSE
- Responsible for the Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDPS) data flow and related risk adjustment initiatives. This involves oversight of risk adjustment data, analytics, operations, and vendors. Responsible for analyzing risk data to identify opportunities to improve risk scores and the quality and effectiveness of initiatives. Serves as the subject matter expert in risk adjustment.
- EXPERIENCE/EDUCATION/QUALIFICATIONS
- Bachelor's Degree or equivalent experience required.
- Three (3) years related experience in a health care or insurance environment required.
- Experience with computer applications, including MS Office (Excel, Word, PowerPoint) required.
- Experience with ICD-10, CM and CPT coding terminology preferred.
- Experience with insurance databases in health plans management preferred, specifically FACETS.
- KNOWLEDGE/SKILLS/ABILITIES
- Effective written and verbal communication skills to perform group presentations, tactfully discuss issues, and listen to and understand concepts, rules and procedures. Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.
- Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.
- PHYSICAL DEMANDS
- Rarely (1 - 10% of the time)
(11 - 33% of the time)
Frequently
(34 - 66% of the time)
Continually
(67 – 100% of the time)
CLIMB - STAIRS
LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs
LIFT (Knee to chest: 24"-54") 0 – 20 Lbs
LIFT (Waist to Eye: up to 54") 0 - 20 Lbs
CARRY 1-handed, 0 - 20 pounds
BEND FORWARD at waist
KNEEL (on knees)
STAND
WALK – LEVEL SURFACE
ROTATE TRUNK Standing
REACH - Upward
PUSH (0 - 20 pounds force)
PULL (0 - 20 pounds force)
SIT
CARRY 2-handed, 0 - 20 pounds
ROTATE TRUNK Sitting
REACH - Forward
MANUAL DEXTERITY Hands/wrists
FINGER DEXTERITY
PINCH Fingers
GRASP Hand/Fist
PI255703860
