Healthcare Insurance Provider Liaison

Seeking a Healthcare Insurance Provider Liaison, who has a Certified Risk Adjustment Coder (CRC) Certification, who will represent our client, a major Healthcare Insurance organization, at some of the largest Health System providers in the Baltimore MD area. The selected candidate will be engaging with patients and shepherding them into care by scheduling appointments with their primary. The selected candidate will serve to meet the goals and interests of the health insurance plan, the provider group and the member by enhancing the coordination and removing points of abrasion between all three. Responsibilities Include:

- Ensure patients complete all relevant test and screenings in accordance with the NCQA HEDIS- recommendations. Support ongoing effort to produce accurate EMR codes and mapping.
- Collaborate with providers to ensure that all chronic conditions are captured at the highest possible level of specificity to ensure that Risk Adjustment Revenue is accurate and reflective of the patients true managed care needs
- Educate patients on and assist with navigating the various aspects of their insurance plan including but not limited to submitting prior authorizations, determining cost shares, obtaining referrals, checking formularies & finding in-network doctors/services
- Promote the various value-added benefits available to patients such as care management, clinical programs, incentives, gym memberships, mail order pharmacy etc. and assist patients with enrollment
- Fulfill various requests (for patients- charts, clinical information etc.) made of the provider by the health plan that are normally handled by the providers office staff.
- Maintain a repository of information needed for various audits initiated by regulatory bodies such as NCQA and CMS.
- Assist with coordination of care through key care transitions to avoid potential complications and costly readmissions
- Ensure that patients have an excellent experience while in the providers office and leave in such a way that they are likely to respond positively to experience surveys such as the Consumer Assessment of Healthcare Providers and Systems
- Work with members to refill medications in a timely manner to ensure proper medication adherence to drugs used to maintain chronic conditions

Want to learn more about this contract to permanent opportunity? Then you should contact Elite Technical right away for consideration!

Required Skills

- Bachelors or Associates is required. Certified Risk Adjustment Coder Certification is also required
- Min. of 3+ years of working for a health plan, in a large provider practice or some combination of bother experiences. Must have suburb customer service skills and abilities
- Knowledge of the Medicare, Commercial and Medicaid Risk Adjustment programs is required.
- Experience with electronic medical records is Required. Ideally Epic or Cerner, others are acceptable.
- Experience and strong knowledge of Quality Concepts such as HEDIS-, Medication Adherence, CAHPS & HOS
- Ability to navigate member benefits across multiple product lines including Commercial, Medicaid and Medicare Advantage
- Working knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS and CPT-4 coding, coordination of benefits
- Strong planning, organizational, interpersonal, verbal, and written communication skills
- Ability to handle multiple priorities and meet deadlines

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Balitmore, MD



Anticipated Start Date

Monday, June 5, 2023

Job Type


Anticipated Duration

6-12 month T2P

Date Posted

Wednesday, May 3, 2023

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Elite Technical Services, Inc. participates in the E-Verify program to confirm the employment eligibility of all persons hired. This means that we will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee's Form I-9 to confirm work authorization. Elite Technical Services, Inc. will not use E-Verify to pre-screen job applicants.

Elite Technical Services, Inc. is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.