Job Closed

This listing is no longer active.

Excellus BlueCross BlueShield logo
Excellus BlueCross BlueShield

UPSTARS – продуктова IT-компанія, з якою злітають і люди, і бренди. Наш основний фокус – технологічні рішення та B2B-послуги для міжнародних клієнтів.

Risk Adjustment Project Coordinator I/II/III

Location

United States

Posted

80 days ago

Salary

$20 - $38 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

Risk Adjustment Project Coordinator I/II/III

Excellus BlueCross BlueShield

Job Description: Summary: The Risk Adjustment Project Coordinator supports the risk adjustment initiatives for Excellus Health Plan. Essential Primary Responsibilities/Accountabilities: Level I: - Review, monitor and track the medical record retrieval reports to identify provider issues such as but not limited to, refusals to comply with medical record requests. - Initiate outbound phone calls to noncompliant providers to resolve provider refusal and/or concerns related to the Health Plan’s request for medical records. - Builds and maintains strong working relationship with providers and office staff. - Educate providers of their contractual obligation to comply with Health Plan’s request in a professional manner to minimize provider abrasion. - Directly negotiates with providers to procure scheduled commitment to deliver requested medical records, retrieval method, and payable fees for the medical records. - Identify and escalate program related issues to the Project Manager and/or Manager as appropriate. - Identify patterns generated by external and internal action effecting provider adherence as it relates to medical record requests. - Communicates issues/findings to the Project Manager and appropriate team members. - Responsible for collecting and scanning project related documents and disbursing to the appropriate audience. - Analyze, compile, and prepare retrieved medical records for transfer. - Initiate Health Plan check requests for provider payments. - Collaborate with various stakeholders to resolve provider issues to relative to medical record retrieval activities. - Fosters an environment of continuous improvement and encourages innovative thinking. - Constantly exploring ways to increase efficiencies and productivity, reducing waste, and reducing costs. - Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. - Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. - Regular and reliable attendance is expected and required. - Performs other functions as assigned by management. Level II (in addition to Level I essential responsibilities/accountabilities): - Manage the respective risk adjustment failed quality assurance (QA) medical records reports through research and analysis to include but not limited to, review/verify medical record failed according to QA guidelines, triage 2nd level review of as needed, identify problematic trends, prepare summary of trends for review and discussion. - Monitors and reports on the progress of the resolution of high impact problems according to established standards. - Identify opportunities through trend analysis for improvement including but not limited to, non-compliant providers, medical recording targeting anomalies, vendor retrieval processes. - Serve as designated liaison between special handle provider that include, large provider groups and hospitals. - Initiate communication with special handle providers of upcoming medical record requests campaign. - Directly negotiate with special handle providers to procure schedule commitment, payments, etc. - Initiate requests for customized reports for special handle providers and deliver to the requestor. - Performs daily data import to the Provider Issue Tracking database, assign provider escalation work items to the Project Coordinators, etc. - Acts as a resource for team questions. - Monitors and executes reports on provider escalation open inventory. - Serve as the liaison and facilitator for member related requests and/or inquiries relative to the prospective risk adjustment programs. Will triage and track issues through resolution. Level III (in addition to Level II essential responsibilities/accountabilities): - Performs project management duties over small-tier risk adjustment or other initiatives as assigned. - Drives medical record retrieval activities in support of risk adjustment programs. - Works closely with Project Manager providing vendor oversight. - Assist Project Manager to determine project schedules, deliverables, assignments, tasks, project meetings (scheduling and meeting notes), status reporting, communication, and action items, as required. - Assist Project Managers and project teams to track work, tasks, and project assignments in order to keep projects on-time and within scope. - Serve as backup for Project Manager as needed. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels: - Associate degree in Business Administration or related field required. In lieu of degree, High School Diploma and three years related work experience required. - One year of related work experience required. - Demonstrates ability to operate within shifting priorities, demands and timelines. - Persuasive, encouraging, and motivating. - Strong all-around soft skills and high level of proficiency using written and oral communication skills - Demonstrated problem solving skills. - Strong organizational skills and ability to prioritize, multi-task, and work in a fast pace environment - Demonstrates technical proficiency in the following applications: MS Teams, Outlook, Word, OneNote and Excel. - Knowledge of claims, provider, and membership systems - Demonstrates ability to work effectively as a member of a team Level II (in addition to Level I minimum qualifications): - Four years related work experience is required. - A relevant bachelor’s degree is preferred. - Self-motivated; ability to take initiative and ownership. - Interfaces effectively with all levels of management. - Demonstrated analytical and business process development skills. - In-depth knowledge of Health Plan Operations and/or Risk Adjustment Operations. - Ability to maintain poise and composure under pressure and in difficult situations. Level III (in addition to Level II minimum qualifications): - Six years of related work experience is required. - Strong meeting facilitation skills - Ability to create, and manage project plans and schedule - Experience in drafting both internal and external communications to convey project findings and status. - Adept at conducting research when project-related issues occur - Expert knowledge of Health Plan Operations and/or Risk Adjustment Operations - Experience drafting concise and informative communication pieces at the department and/or project team level. Physical Requirements: - Works from a desk most of the time. ************ In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: Grade N5: Minimum $20.02 - Maximum $33.03 Level II: Grade N6: Minimum $21.83 - Maximum $34.92 Level III: Grade N7: Minimum $23.56 - Maximum $37.70 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Related Categories

Related Job Pages

More Risk Jobs

Freudenberg Group logo

IT Governance Manager

Freudenberg Group

The Freudenberg Group is an equal opportunity employer that is committed to diversity and inclusion. Employment opportunities are available to all applicants and associates without regard to race, color, religion, creed, gender (including pregnancy, childbirth, breastfeeding, or related medical conditions), gender identity or expression, national origin, ancestry, age, mental or physical disability, genetic information, marital status, familial status, sexual orientation, protected military or veteran status, or any other characteristic protected by applicable law.

Risk80 days ago
Full TimeRemoteTeam 10,001+Since 1849H1B No Sponsor

• Establish, maintain, and continuously evolve IT governance frameworks, policies, and standards. • Implement and monitor adherence to IT rules, procedures, and regulatory requirements across all teams. • Provide expert guidance on IT process design and continuous improvement initiatives. • Define KPIs for governance effectiveness, track performance, and drive data-informed decision-making. • Design and deliver training programs on governance policies, compliance requirements, and best practices. • Lead preparation for internal and external audits, ensuring accurate documentation and timely follow-up on findings. • Act as a pro-active, trusted advisor to leadership teams, bridging communication between business, IT, and compliance functions.

Italy
Job Closed

Nurse, Care Management

Cano Health

Cano Health specializes in personalized primary care, dedicated to treating patients as whole individuals and enhancing their quality of life. With expert doctors and compassionate

Risk80 days ago

It's rewarding to be on a team of people that truly believe in making an impact! We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us. Job Summary The Nurse, Care Management is a compassionate and skilled clinician responsible for coordinating and managing comprehensive care plans tailored to individual patient needs. This role collaborates closely with physicians, interdisciplinary teams, and community resources to ensure seamless, high-quality care delivery across the continuum. The nurse focuses on improving patient outcomes, reducing care fragmentation, and enhancing overall quality of life. In this role, the nurse will assess physical and psychosocial health, identify gaps in care, and advocate for necessary services. Responsibilities include educating patients and families, facilitating transitions of care, and monitoring progress to adjust plans as needed. Success in this role requires strong clinical judgment, excellent communication skills, and a commitment to patient-centered care Essential Duties & Responsibilities - Conduct patient outreach to complete assessments, coordinate care, and provide resources. - Create, implement, and update individualized care plans for patients enrolled in care management programs. - Educate patients and families on disease processes, preventive screenings, and health maintenance. - Maintain accurate and timely documentation of patient encounters, progress, and case notes. - Facilitate interdisciplinary care team meetings and communicate patient progress, barriers, and care needs to providers, families, and team members. Supervisory Responsibilities - No supervisory responsibilities. Education & Experience - Bachelor’s degree preferred; four years of related clinical experience required - 2-3 years of nursing experience, with at least 1–2 years in care management, case management, utilization management, or care coordination. - LPN required, RN preferred Education Requirements Education Level Discipline Required Bachelor's Degree Knowledge, Skills & Proficiencies - Proficiency in Microsoft Office and EMR systems; familiarity with Salesforce preferred - Excellent written and verbal communication skills - Strong organizational and time management abilities - Effective motivational interviewing and telephonic nursing skills - Ability to work independently while collaborating within an interdisciplinary team - Bilingual (English/Spanish) preferred Physical Requirements This position works under usual office conditions. The associate is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include ability to lift up to 50 lbs. The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work Conditions Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasionally climbing. Travel Requirements Amount of Expected Travel Details Yes 0-25% May require travel to off-site clinics, hospitals, or other healthcare settings. Tools & Equipment Used Computer and peripherals, standard and customized software applications and tools, and usual office equipment. Disclaimer The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain, or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. Join our team that is making a difference! Please see Cano Health’s Notice of E-Verify Participation and the Right to Work post here

United States
Job Closed
Full TimeRemoteTeam 1,001-5,000H1B No Sponsor

JOB DESCRIPTION SUMMARY: - The Sr Client Service Specialist works closely with advisors, line of business specialists, and dedicated client servicing professionals to analyze client data, evaluate needs, and help create effective risk management solutions designed to meet clients' financial goals. PRIMARY RESPONSIBILITIES: - Responsible for gathering the information and risk management recommendations for renewals and for delivering renewals and/or binders as needed. - Manages all policy activity aspects of assigned accounts including endorsements and invoicing. - Presents new business and renewal risks to the insurance marketplace for quoting. - Maintains a concern for timeliness and completeness when interacting with clients, the organization, and Insurance Company Partners to minimize potential for errors and omissions claims. - Responsible for developing deep understanding of assigned accounts and placement strategy - Cultivates strong relationships with Insurance Company Partners and is responsible for knowing carrier requirements and attributes. KNOWLEDGE, SKILLS & ABILITIES: - Exhibits excellent client service and problem-solving skills. - Can comfortably work in a team environment. - Possesses intermediate to advanced knowledge of Microsoft Word, Excel, PowerPoint, and Outlook and the ability to learn any other appropriate insurance company and firm software programs. EDUCATION & EXPERIENCE: - A Bachelor’s degree is preferred. - At least 2 years’ relevant experience. - Current P&C license as required by the State Department of Insurance to effectively service clients or be willing and able to obtain all required licenses - Demonstrates effective presentation skills through verbal and written communications. - Demonstrates the organization’s core values, exuding behavior that is aligned with corporate culture. #LI-REMOTE #LI-JL1 IMPORTANT NOTICE: - This position description is intended to describe the level of work required of the person performing in the role and is not a contract. The essential responsibilities are outlined; other duties may be assigned as needs arise or as required to support the organization. All requirements may be subject to reasonable accommodation to applicants and colleagues who need them for medical or religious reasons. Click here for some insight into our culture! The Baldwin Group will not accept unsolicited resumes from any source other than directly from a candidate who applies on our career site. Any unsolicited resumes sent to The Baldwin Group, including unsolicited resumes sent via any source from an Agency, will not be considered and are not subject to any fees for any placement resulting from the receipt of an unsolicited resume.

United States
American Chemical Society logo

Intern, Volunteer Engagement

American Chemical Society

The American Cancer Society Cancer Action Network (ACS CAN) is the nation's leading cancer advocacy organization. Together with our charitable partner, the American Cancer Society, we work in Congress, state legislatures and local jurisdictions to support evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem.

Risk80 days ago
Full TimeRemoteTeam 1,001-5,000

At the American Cancer Society, we're working to end cancer as we know it, for everyone. Our employees and 1.3 million volunteers are raising the bar every single day. We are a culture comprised of diverse backgrounds and experience, to better serve our communities. The people who work at the American Cancer Society focus their diverse talents on our lifesaving mission. It is a calling. And the people who answer it are fulfilled. The Volunteer Engagement Operations Intern supports key projects and daily tasks that help create a positive, consistent volunteer experience across the organization. This role provides hands‑on experience in project coordination, operations, and resource management while learning how volunteer engagement supports our mission. ESSENTIAL FUNCTIONS: - Support project coordination for volunteer engagement initiatives by helping track tasks, timelines, and updates. - Assist with maintaining and updating volunteer resources, including guides, tools, training materials, and documentation. - Provide daily operational support, such as monitoring shared inboxes or platforms, ensuring requests are logged and tracked, and escalating issues as needed. - Help prepare simple artifacts (e.g., summaries, templates, draft materials) used for departmental planning and management. - Complete a volunteer engagement special project, with guidance from the Volunteer Engagement team. The finished project will be a tangible work sample the intern can highlight on their resume and in their portfolio. WHAT YOU’LL LEARN: - How volunteer engagement functions at an enterprise level. - Basics of project management and operational process support. - How cross‑departmental collaboration contributes to organizational goals. - Skills in documentation, communication, and workflow coordination. EXPERIENCE/QUALIFICATIONS: - Minimum Degree Required: ​Bachelor's Degree​ completed or currently in progress with at least two years of higher education completed preferably in business, nonprofit management, public administration, social sciences or a related field. - Preferred Degree: ​Associate Degree​. - Years of experience: 2-3 years of work or volunteer experience. - Timeframe: June – September 2026. KNOWLEDGE, SKILLS, AND ABILITY: - Strong aptitude for technology, including comfort learning new systems and tools. - Ability to collaborate effectively across teams and communicate clearly with diverse stakeholders. - Strong organizational skills, with attention to detail, and the ability to manage multiple priorities in a fast-paced environment. - Critical thinking and problem-solving skills. - Self-motivated, curious, and eager to learn, with a willingness to ask questions, and take initiative. - Demonstrated interest in pursuing a career in nonprofit management or mission-driven work. - Genuine passion for volunteerism and community impact. TRAVEL REQUIREMENTS: - None. This position is fully remote and collaborates with a team across the United States. If the intern lives near an ACS office, arrangements may be made for optional in‑office work, allowing them to interact with staff and gain exposure to organizational culture and in‑person work dynamics. PHYSICAL REQUIREMENTS: - Work is normally performed in a typical interior/office work environment. - No or very limited physical effort required. - No or very limited exposure to physical risk. POSITION REQUIREMENTS: - Full-time student, if you are an undergraduate student, you have completed your freshman year of college. - Have a minimum of a B average (cumulative 3.0 on 4.0 scale). Plan to continue your education in the following term/semester. - Upload a resume upon application submission. - Note: an internship assignment may coincide with your last term/trimester as a full-time student, but the internship must be disengaged upon graduation. The starting rate is $18 - $20/hour. The final candidate's relevant experience/skills will be considered before an offer is extended. Actual starting pay will vary based on non-discriminatory factors including, but not limited to, geographic location, experience, skills, specialty, and education. ACS provides staff a generous paid time off policy; medical, dental, retirement benefits, wellness programs, and professional development programs to enhance staff skills. Further details on our benefits can be found on our careers site at: jobs.cancer.org/benefits. We are a proud equal opportunity employer.

United States
$18 - $20 / hour