Sixteenth Street Community Health Centers Hiring For Population Health Specialist at Milwaukee, WI  Full Time

Job Responsibilities:

The Population Health Specialist utilizes information from several sources, both internal and external to the organization, to identify gaps in patient care aligned with Value Based Care programs and performs patient outreach to support closure of those gaps. 

1. Pull data and reports from multiple databases/portals and electronic health records to identify potential care gaps and follow the appropriate process to close those gap(s).
2. Work collaboratively with appropriate care teams to notify teams of missing documentation or to obtain documentation to close identified care gaps.
3. Perform outreach to patients in accordance with organizational policies and procedures to schedule follow-up appointments, conduct screenings or obtain patient reported documentation to facilitate closure of identified care gaps.
4. Work with payors to understand individual program requirements to close gaps and follow established processes within HIPAA regulation compliance.
5. Attend meetings and work with payors to obtain monthly reports and access to portals per their established protocols.
6. Work with payors to more accurately reflect patient attribution.
7. Ensure accuracy and timeliness in submission of records to payers.
8. Develop workflows and processes to attain targets established by the organization and value-based contracts.
9. Utilize Office suite applications, EMR, and data management techniques to provide appropriate level of detail for problem solving and continuous improvement.
10. Participate in regular department and organizational meetings
11. Remain current with Motivational Interviewing skills.  May involve taking occasional courses
12. Provide patient education in clear, professional manner and in a manner that is understandable to patient and/or family.
13. Participate and support other tasks, such as patient navigation, for defined quality or value based programs.
14. Comply with processes developed to ensure documentation requirements follow HIPAA regulations.