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ACO Operations Associate

Clover Health

Remote / United States of America
  • Job Type: Full-Time
  • Function: Operations
  • Industry: Digital Health
  • Post Date: 11/22/2022
  • Website: cloverhealth.com
  • Company Address: P.O. Box 471, Jersey City, NJ 07303

About Clover Health

Clover Health is a data driven health insurance startup driving to improve the overall state of healthcare in America. We are hiring software engineers, data scientists, designers and product folks who can help us understand our members’ wellness and steer them clear of any health risks down the road.

Job Description

Clover is reinventing health insurance by working to keep people healthier.

We value diversity — in backgrounds and in experiences. Healthcare is a universal concern, and we need people from all backgrounds and swaths of life to help build the future of healthcare. Clover's Value Based Care team is responsible for the development and implementation of programs to support the growth and long term success of our Direct Contracting / ACO REACH initiative.

We are hiring for a (Senior) Accountable Care Organization (ACO) Operations Associate who will support the implementation, onboarding and ongoing administrative support for ACO providers. In this role you will rely on your expertise in beneficiary alignment, provider communications, claims processing, EHRs, medical billing and coding, and physician reimbursement models to help service our network of ACO providers.

As an ACO Operations Associate, you will:

  • Respond to provider inquiries and requests related to data sharing, voluntary alignment, reimbursement terms, payments, contract collection, provider administration manuals and required CMS provider written notifications/communications. 
  • Maintain and complete various daily activities pertaining to internal administration of provider operations, in general (i.e. alignment tracking, payment tracking, incentive tracking, contract maintenance, provider communications, provider onboarding, etc.)
  • Manage claims inquiries and claims issue resolution in partnership with the Claims Operations team.
  • Collect updated provider demographic data and submit updates to the Provider Data Management team.
  • Educate and support providers who choose to voluntarily align beneficiaries to their practice.
  • Ensure providers have completed the ACO compliance training.
  • Support end-to-end contract ingestion pipeline, ensuring any/all documents are appropriately completed and submitted, appropriate internal stakeholders are notified, and key artifacts are stored correctly.
  • Support insight development/data report building at the request of the ACO leadership team.
  • Support maintenance of ad-hoc analyses/reporting requests.

You will love this job if:

  • You are service oriented — you feel fulfilled in helping and supporting others to achieve common goals and resolve issues.
  • You are a team player. You enjoy partnering with others, and want to work collaboratively to find new solutions.
  • You are a strong communicator. You have strong verbal and written communication skills that foster trust, knowledge sharing, and progress.
  • You are detail-oriented. You pay attention to the small things, while understanding how they fit into the bigger picture.
  • You have a bias to action and love to move quickly from ideas to execution.
  • You use analytical input to solve complex problems.
  • You are curious. You like to do research when you don't know an answer. You ask the hard questions and you don't sweep problems under the rug.

You should get in touch if:

  • You have a 3+ years Medicare healthcare experience, ideally in value-based care.
  • You have 1+ years experience supporting provider engagement.
  • You have a great understanding of healthcare topics, such as claims processing, EHRs, medical billing and coding and physician reimbursement models.
  • You have a working understanding of healthcare topics, pertaining to providers, such as, physician reimbursement models, data sharing in provider partnerships, and PCP engagement.
  • You have a basic understanding of provider contract options, healthcare economics and competitors practices with the ability to grasp both clinical and business concepts.
  • You have strong project management or administrative skills and can multi-task while being highly organized and thorough. 
  • You are able to create buy-in and drive action across a wide set of collaborative team members.
  • You have a proven ability in using data to inform decision-making as part of a broader, strategic set of goals.
  • You are able to regularly identify opportunities to implement efficient process/operational improvements.
  • You have a working knowledge of Excel and are able to produce basic reports when requested.

 

#LI-Remote

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.


About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.

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