It’s Time For A Change…Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
What You’ll Be Doing:
This position is responsible for coordination of the department’s intake and assignment process of issues impacting claims processing.
1.Triages incoming issues impacting areas of operation by conducting high level review and assigns to appropriate department, and analyst, if applicable.
2. Provides support in the review and resolution of escalated issues submitted by, but not limited to, internal departments, external parties and regulatory agencies (DMS, CMS, etc..)
3.Attends internal meetings and takes notes to assist in issue resolution.
4. Assists in post-project completion audit development to ensure production updates are in accordance with plan policies and provider contracts.
5. Works with cross-functional development teams to help establish data quality standards and documentation.
6. Assists with departmental projects when needed and contributes to completion of projects by a given deadline.
7. Performs other duties and projects as assigned.
Key Competencies/Success Factors:
- Lives the values: Integrity, Community, Collaboration and Stewardship, as defined in the performance appraisal.
- Displays the ability to work within the team as an advocate for both the internal and external customers.
- Utilizes independence and initiative by competently following up on matters requiring attention without needing reminders.
- Demonstrates flexibility and cooperation when faced with changing priorities to meet shifting needs.
- Exhibits behavior which will enhance office morale through positive attitude and actively working by the Passport mission and values
- Displays initiative, flexibility, and team support to ensure efficient and effective operations. Displays a positive attitude, self-motivation, objectivity, and the ability to handle confidential matters appropriately.
- Ability to handle multiple priorities, facilitate team development and interface with front line associates and management.
- Proficient experience using Outlook, Word, Excel and PowerPoint in a Windows operating system.
- Excellent communication skills (verbal, written and listening)
- Investigative, decision-making, problem solving, interpersonal and organizational skills required
The Experience You’ll Need (Required):
- Prior experience in the Healthcare or Managed Care industry.
- Knowledge of Medicare/Medicaid reimbursement methodologies.
- Experience in claims adjudication, auditing or comparable
- Experience with the Aldera or Other claims processing system.
- Excellent oral and written communication skills, including presentation skills required.
Preferred (Not Required):
- Bachelor’s degree in health care, business, or related field or related work experience.
- Preferred understanding to analytics or related work experience.
- Knowledge of and medical terminology and coding.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.