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Job Title
Project Manager

Location
Weston

Facility
CC Florida Weston

Department
Managed Care-Finance

Job Code
000629

Shift
Weekend Days

Schedule
8:00am-5:00pm

Job Summary
Responsible for oversight and analysis of Payment Innovations (PI) and Value Based Care (VBC) metrics across the Cleveland Clinic Florida region. Coordinates with M&NS team to understand all active VBC programs and available financial incentives. Coordinates with the VBC core team, Clinically Integrated Network, Hospital and Clinic Center leadership to support PI and VBC revenue optimization opportunities. Collaborates with VBC core team, Clinically Integrated Network, Hospital and Clinic Center leadership to support PI and VBC revenue optimization on projects that drive shared savings, quality care gap closure and other PI and VBC revenue opportunities (e.g. implementation of quality driven clinical workflows with operation teams, identification of potential compliance concerns, and documentation initiatives). Serves as point of contact for communicating PI and VBC program information to Hospital and Clinic Center leadership. Serves as primary resource to coordinate questions and responses for issues that arise within value based care initiatives as it relates to Hospitals and Clinic Centers.

Job Details

Responsibilities:

• Research and validate Payment Innovation opportunities as released by CMS.
• Initiates the collaboration of service line strategies with key stakeholders under the direction of M&NS (e.g., Sr. Director of VBC & CIN, Hospital and Clinic Center leadership)
• Assist in creating or outlining goals to aid the VBC & CIN team in achieving program metrics
• Prepares, documents, or tracks action plans and timelines for PI and VBC program efficiencies
• Gathers and organizes payer related performance reports (e.g., HEDIS/quality scorecards, financial reports).
• Manage the distribution of monthly payer member rosters to appropriate stakeholders.
• Helps prepare and present business cases intended to improve VBC and PI outcomes.
• Serves as a liaison with all levels of the organization and outside community.
• Manages multiple priorities and projects with competing deadlines.
• Allocates time to meet completion requirements. Subject matter expert for other positions in the organization.
• Coordinates and cascades value based reimbursement information received to key stakeholders.
• Monitors and distributes value based metrics to involved stakeholders.
• Develops strong working relationships with Hospital and Clinic Center leadership to collaboratively seek solutions to meeting value based care metric thresholds.
• Partners with value based care operations to reinforce recommended changes to address performance gaps (e.g., HEDIS trends, payor metrics, technology, etc.)
• Partners with value based care operations to facilitate educational needs to administrators, physicians, providers and nurses related to coding and reimbursement.
• Achieves operational objectives by contributing information and recommendations to strategic plans and reviews.
• Resolves problems.
• Determines system improvements and implements change.
• Analyzes variances and initiates corrective actions in value based care areas where discrepancies exist between our expectations and payers information.
• Explores opportunities to add value to job accomplishments.
• Other duties as assigned.

Education:

• High School diploma required.
• Associate's Degree or Bachelor's Degree in Business Administration or related field preferred.

Certifications:

• Certified Professional Coder (CPC) or Certified Outpatient Coder (COC) from the American Academy of Professional Coders or Certified Coding Specialist/Physician (CCS/P), or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) from the American Health Information Management Associate required.

Complexity of Work:

• Strong communication and problem solving skills.
• Strong knowledge of coding, revenue cycle process, and enterprise systems.
• Ability to deal with complex situation with high degree of independence.
• Critical thinking skills.

Work Experience:

• Bachelor's degree: A minimum of 3 years of coding experience, including a minimum of 1 year in a lead role in Coding and Reimbursement environment.
• Associate's degree: A minimum of 4 years coding experience, including 1 year in a lead role in Coding and Reimbursement environment.
• High School diploma: A minimum of 5 years of coding experience, including 3 years in lead role in Coding and Reimbursement environment.

Physical Requirements:

• Manual dexterity to operate office equipment.
• May require extended periods of standing, walking, or sitting.
• Good visual acuity through normal or corrected vision.

Personal Protective Equipment:

• Follows Standard Precautions using personal protective equipment

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our employees and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. Job offers will be rescinded for candidates for employment who test positive for nicotine. Candidates for employment who are impacted by Cleveland Clinic Health System's Smoking Policy will be permitted to reapply for open positions after 90 days.

Cleveland Clinic Health System administers an influenza prevention program as well as a COVID-19 vaccine program. You will be required to comply with both programs, which will include obtaining an influenza vaccination, COVID-19 vaccination, or an exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.

Please review the Equal Employment Opportunity poster.

Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities