-Coordinate implementation of population health management plans with independent physicians who wish to be enrolled, or are currently part of an IPA or ACO.-Responsible for the management of the overall utilization rates and assist to reduce unnecessary healthcare spending.-Obtain, review and utilize population health data, risk and cost analyses to affectpositive change in beneficiary outcome.-Coordinate patient outreach as needed for discharge planning, case management, and ACO/IPA reporting.

Clinical Subject Matter Expert:-Define and refine clinical offerings in hospital and sub-acute provider markets.-Identify key targets and functions within the hospital market for clinical solutions outreach andengagement.-Provide relevant content to support marketing and sales activities. This content includes furthersolution definition, blog posts, articles, white papers, and case studies.Sales Support:-Act as a support resource for clinical solution-based sales opportunities.-Participate in sales presentations with potential new clients. Be available to interact with andrespond to clinical based inquiries.-Engage in networking activities to generate new sales opportunities, including participation inindustry conferences.-Lead solution scoping activities and proposal generation for clinical solution opportunities.-Support later stages of the sales process, including proposal negotiation, Statement of Work(SOW) creation, and closing details.Onshore Support for Q/A Process:-Allocate 25% of capacity to support the Quality Assurance process for clinical-based clients.-Collaborate with the Q/A team to ensure the quality and compliance of clinical solutions.Account Management:-Lead the implementation process for new hospital-based clients, ensuring a smooth onboardingexperience.-Provide ongoing account management support for new hospital-based clinical solution clients.-Foster strong relationships with clients to understand their evolving needs and ensure customersatisfaction.

• Managed teams for a portfolio of clients, varying from multi-hospital systemsto physician practices, ensuring turn around time and quality foreach client.• Collaborated across teams of up to 160 members to define goalsand commitment to timelines and deliverables.• Developed creative and practical solutions based on evaluationof multiple factors.• Developed presentations to communicate project status toclients.• Recommended improvements to established businessprocesses, enabling better project turnaround timeframesincluding new software development.• Pivoted quickly between clients, adapting to shifting expectationsand client goals.• Led meetings to detail project milestones, brainstorm ideas anddetermine appropriate techniques to manage tasks.

Established and maintained relationships with individual and business customers and provided assistance with problems these customers may encounter.• Planned, directed, or coordinated activities of workers in branches, offices, or departments of establishments, such as branch banks, brokerage firms, risk and insurance departments,or credit departments.• Submitted delinquent accounts to attorneys and outside agencies for collection.• Provided assistance to internal and external auditors in compliance reviews.• Recruited staff members and oversaw training programs.

Maintain current knowledge of ICD-10 and CPT coding, HEDIS measure technical specifications, NYS and CMS documentation requirements.Assess current system issues and provides training to leverage electronic medical record and population health portal functionality that supports practice standards and patient outcomesCollaborates with the regional medical leadership and practice leadership to enhance the training experience and identify adoption and optimization strategies in order to achieve expected outcomesUse data and reports to analyze key cost, utilization and quality data and interpret results to assess the performance of the practiceDevelop and maintain positive working relationships with physicians and practice leadership, serving as first-line support for all requirements and questionsIntegrate company technology tools into practice workflowsBuild and effectively maintain relationships with team members across both the IPA, ACO, and community

Process prior authorizations received from health providers via phone, fax and web submissionsSuggest resources to support the team of processors grow in content knowledge and problem-solving skills.Develop a comprehensive understanding of the Clinical Review processes that currently exist and additional processes that are needed to improve consistency and quality.Make sure day-to-day processes are executed in a timely and accurate manner, in compliance with state specific regulations.