Insurance Quality Plan Manager
LMHP Administration
Licking Memorial Health Systems (LMHS) is a leading, non-profit healthcare organization, passionately dedicated to improving the health and well-being of our community. With a history dating back to 1898, LMHS remains a cornerstone of healthcare excellence, catering to the evolving needs of Licking County. Our cutting-edge facility provides a comprehensive spectrum of patient care services, from life-saving emergency medicine to the comforting embrace of home healthcare, with a unique range of specialized medical services, including cancer, heart health, maternity, and mental wellness.
When you join the LMHS team, you become a vital part of your local community Hospital. Working at LMHS is not just a job, it is a unique opportunity to directly impact the health and well-being of your friends, family, and neighbors. You will be providing care in a place in which you are personally connected, where the impact of your work extends beyond the Hospital doors and into the heart of our community. Our commitment to diversity, equity, and inclusion ensures that every member of our community is served with respect and compassion. Join us in our mission – dedicated to patient safety, utilizing state-of-the-art technology, and with a passionate team of highly trained and compassionate individuals who strive to improve the health of the community.
Position Summary
Works in collaboration to track and coordinate provider registration, attestation and realization for payments for incentive programs, including but not limited to MU, PQRS, and VBPM. Under the direction of the Vice President Physician Practices, serves as the primary contact for the EHR incentive programs. Coordinates, monitors, assesses and evaluates tracking and reporting projects pertaining to the incentive programs. Monitors, prioritizes and assesses accurate electronic exchange of information to improve coordination of care, tracking outcomes, identify cost and improve consumer engagement thus strengthening operational leadership relations and therefore producing efficiency gains. May be required to perform other duties as requested.
Responsibilities
- Understand and monitor Epic EMR functionality, forms, workflows, and relevant Epic reporting dashboards regarding MIPS, Meaningful Use, and Promoting Interoperability programs applicable to the Licking Memorial Health Professionals.
- Maintain current authentication and update provider eligibility/participation status for CMS Quality Payment Programs (QPP).
- Monitor legislation for rule changes and proposed/finalized rules published in The Federal Register that impact the organization’s participation in the Quality Payment Programs.
- Maintain contracts with third-party vendors for quality reporting and The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.
- Lead audit processes for the Quality Payment Programs relevant to Licking Memorial Health Professionals, most notably the Merit-Based Incentive Program System (MIPS). Communicate and serve as a liaison between auditors, providers, and physician center managers.
- Support organization processes by serving as a subject matter expert for the CMS Quality Payment Programs. This includes monitoring and providing education as needed related to workflows and office procedures to improve quality and promoting interoperability.
- Provide education to new employees during orientation and ongoing support for PCMs and leadership regarding workflows and applicable QPP measures.
Requirements
- Previous experience within the healthcare sector
- Familiarity with Epic EMR functionality and reporting is required
- Demonstrated experience in vendor management for quality reporting
- A degree in computer science, healthcare administration, business administration, public health, or a related field is preferred. Equivalent relevant experience will be considered.
- RN or another clinical role preferred
Licking Memorial Health Systems is an equal opportunity employer and maintains compliance with all state, federal, and local regulations. Licking Memorial Health Systems does not discriminate against applicants because of race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit-based factors protected by law.
